Journal name: World Journal of Pharmaceutical Research
Original article title: Bilateral parotid glands swelling and facial palsy as relapsing symptom in adult patient with acute lymphoblastic leukemia
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Subtitle: a case report
Original source:
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Ahmed Mjali, Haider Hasan Jaleel Al-Shammari, Doha Maytham Hasan, Mohammed F. Alqanbar and Mohammed Jawad Al-Anssari
World Journal of Pharmaceutical Research:
(An ISO 9001:2015 Certified International Journal)
Full text available for: Bilateral parotid glands swelling and facial palsy as relapsing symptom in adult patient with acute lymphoblastic leukemia
Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research
Doi: 10.20959/wjpr201811-11696
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Summary of article contents:
Introduction
Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the blood and bone marrow, predominantly in younger populations. While most relapses are observed in the bone marrow or lymphoid tissues, relapses can also occur in extramedullary sites, which is a rare phenomenon. This case report highlights an 18-year-old male patient diagnosed with ALL who presented with an unusual relapse characterized by bilateral parotid gland swelling and facial palsy. Despite aggressive treatment, the patient faced a grave prognosis.
Parotid Gland Involvement in Leukemia
Relapse of ALL specifically in the parotid glands is exceptionally rare, with most literature focusing on pediatric cases or post-allogeneic stem cell transplant settings. In this case, the patient's bilateral parotid swelling was not painful, complicating the clinical presentation. Such involvement may lead to misdiagnosis as an infectious process, particularly in younger patients. The infiltration of leukemic blasts into the parotid glands can also create confusion in diagnosis, delaying appropriate treatment and worsening outcomes.
Presentation and Diagnosis
The patient initially presented with signs of fatigue, pale appearance, and no palpable lymphadenopathy or organomegaly. A blood film diagnosis confirmed ALL, which was substantiated by bone marrow aspiration revealing significant lymphoblast infiltration. Peripheral blood analysis did not detect BCR-ABL, leading to a classification of B-cell acute lymphoblastic leukemia. After achieving remission following initial treatment, the emergence of facial palsy and parotid swelling indicated a relapse, diagnosed via fine-needle aspiration that revealed lymphoblastic infiltration.
Treatment Challenges
Despite treatment with a hyper-CVAD regimen intended to address the relapse, the patient did not achieve successful bone marrow remission. Although the parotid swellings decreased in size after therapy, the overall progression of the disease was concerning. The case underscores the complexities in treating extramedullary relapses associated with ALL and the potential for significant complications, including infections, which can lead to catastrophic outcomes.
Conclusion
The case illustrates the rarity and severity of parotid gland involvement as a presenting symptom of relapse in adult patients with acute lymphoblastic leukemia. With limited existing literature on the matter, this report serves as an important documentation of such a case. The aggressive nature of the disease and refractory response to treatment highlight the need for vigilant monitoring and possibly alternative therapeutic strategies for patients presenting with unusual clinical symptoms associated with leukemic relapses.
FAQ section (important questions/answers):
What was the age of the patient in the case report?
The patient in the case report was an 18-year-old male who presented with symptoms suggesting acute lymphoblastic leukemia.
How was the patient's acute lymphoblastic leukemia diagnosed?
The diagnosis was made through blood film analysis, bone marrow aspiration showing heavy lymphoblast infiltration, and immunophenotypic analysis consistent with B-cell acute lymphoblastic leukemia.
What unusual symptoms did the patient experience during the relapse?
The patient presented with bilateral parotid gland swelling and facial palsy, which are uncommon symptoms for relapsing acute lymphoblastic leukemia.
What treatment did the patient receive after his AML diagnosis?
The patient initially received the UKALL XII regimen, followed by the hyper-CVAD regimen after presenting with new neurological symptoms.
What was the outcome of the treatment for this patient?
Despite treatment, the patient did not achieve bone marrow remission and ultimately died after the second treatment cycle due to disseminated fungal sinusitis.
Is parotid gland involvement common in acute lymphoblastic leukemia?
Parotid gland involvement in acute lymphoblastic leukemia is extremely rare and can lead to misdiagnosis as mumps, delaying treatment.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Bilateral parotid swelling and facial palsy in adult ALL patient”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Swelling:
Swelling refers to the enlargement of the parotid glands in the patient, which was significant in this case report. It indicates a potential infiltration of leukemia cells. Swelling can lead to discomfort and additional complications like facial palsy, making it a critical symptom to monitor in leukemia patients.
2) Disease:
The term 'disease' is pivotal as it signifies the underlying condition being addressed—acute lymphoblastic leukemia (ALL) in this case. Understanding the nature of the disease, its symptoms, progression, and treatment options is essential for effective patient management and determining prognosis.
3) Chemotherapy:
Chemotherapy is a cornerstone treatment for acute lymphoblastic leukemia. In this report, various chemotherapy regimes, such as UKALL XII and hyper-CVAD, were used in an attempt to induce remission. The efficacy of chemotherapy in this context underscores its significance in managing relapsed leukemia cases.
4) Blood:
Blood analysis plays a crucial role in diagnosing and monitoring leukemia. In this case, blood films indicated acute lymphoblastic leukemia through identifiable lymphoblasts. Blood tests are essential for treatment response evaluation, including monitoring changes during chemotherapy, which directly impact patient outcomes.
5) Post:
The term 'post' is relevant in describing the sequence of interventions and outcomes in the case study. For instance, post-chemotherapy results provide insight into the effectiveness of treatment and help assess disease progression, guiding subsequent medical decisions and patient management strategies.
6) Male:
The specification of 'male' indicates the gender of the patient, which is relevant for statistics and understanding demographic factors that can influence disease presentation, treatment response, and outcomes in acute lymphoblastic leukemia. Gender differences may play a role in treatment efficacy and side effects.
7) Discussion:
The 'discussion' section is critical as it summarizes the findings of the case within the broader context of existing literature. It highlights the uniqueness of the case, the rarity of facial nerve involvement, and the implications for understanding extramedullary relapses in acute lymphoblastic leukemia.
8) Knowledge:
Knowledge in this context refers to the accumulated medical understanding and findings derived from the case study. It emphasizes the importance of ongoing education and research in improving the management of acute lymphoblastic leukemia and related complications, reinforcing the need for clinical awareness.
9) Medicine:
Medicine encompasses the science and practice involved in diagnosing and treating diseases like acute lymphoblastic leukemia. This case illustrates the complexity of medical management and the necessity for interprofessional collaboration in providing effective treatment and addressing the patient's unique challenges.
10) Sign:
The term 'sign' relates to clinical indicators or symptoms presented by the patient, such as the parotid swelling and facial palsy. Recognizing these signs is essential for timely diagnosis and appropriate treatment, highlighting their importance in the clinical evaluation of leukemia patients.
11) Line:
In this context, 'line' refers to the sequence of treatments (lines of therapy) the patient underwent. Understanding treatment lines is important in clinical practice, as it sheds light on the patient's response to initial therapies and informs subsequent treatment decisions based on therapeutic efficacy.
12) Pur:
The descriptor 'poor' reflects the unfavorable prognosis associated with the patient's condition, emphasizing the challenging nature of extramedullary relapses in acute lymphoblastic leukemia. Acknowledging poor outcomes guides medical expectations and underscores the necessity for innovative treatment strategies to improve survival.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Bilateral parotid swelling and facial palsy in adult ALL patient’. Further sources in the context of Science might help you critically compare this page with similair documents:
Central nervous system, Clinical presentation, Facial palsy, Poor prognosis.