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Residents’ Corner
3 (
3
); 166-167
doi:
10.25259/JHAS_38_2023

Acute-onset muscle weakness in acute leukemia: A common but often missed cause

Department of Hematology, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
Corresponding author: Kaustav Ghosh, Department of Hematology, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. ghoshrony94@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ghosh K. Acute-onset muscle weakness in acute leukemia: A common but often missed cause. J Hematol Allied Sci. 2023;3:166-7. doi: 10.25259/JHAS_38_2023

An 18-year-old female newly diagnosed with precursor T-cell acute lymphoblastic leukemia presented with progressive pallor requiring recurrent blood transfusions; examination revealed generalized lymphadenopathy and mild splenomegaly. The complete blood count on admission was hemoglobin 7.6 g/dL, total leukocyte count 134,500/cumm (Neutrophils-25%, Lymphocytes-30%, and blasts-45%), and platelet count of 16,000/cumm. The patient was started on the BFM 2002 induction protocol along with prophylaxis for tumor lysis syndrome. On day 3 of therapy, the patient complained of severe bilateral muscle pain and weakness. Examination revealed bilateral lower-limb flaccid paralysis. A serum sample was sent for electrolyte analysis, and an urgent electrocardiogram (ECG) was done. ECG revealed a wide QRS complex with a loss of P waves and a typical “sine wave” pattern [Figure 1]. The patient was immediately started on injection of calcium gluconate, IV glucose insulin drip, salbutamol nebulization, and potassium binding (calcium polystyrene sulfonate) sachet. Later on, biochemistry reports revealed serum potassium 7.6 meq/L, serum calcium 9.6 meq/L, and serum magnesium 2.1 meq/L. Hyperkalemia is a medical emergency that can lead to sudden cardiac arrest; hence, non-specific signs and symptoms such as muscle pain or weakness associated with/without vomiting, palpitations, or chest pain should alert the physician to take appropriate measures.[1]

Figure 1:
Electrocardiogram of an 18-year-old female newly diagnosed with T-cell acute lymphoblastic leukemia with bilateral muscle pain and weakness, showing atypical sine wave pattern with a wide QRS complexes with loss of P wave.

Ethical approval

The Institutional Review Board approval is not required.

Declaration of patient consent

Patient’s consent not required as patient’s identity is not disclosed or compromised.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship

Nil.

References

  1. , . Tumor lysis syndrome In: StatPearls. Treasure Island, FL: StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK518985/ [Last accessed on 2022 Oct 31]
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