Reversible splenial lesion found on brain-screening MRI in acute myeloid leukemia

Abstract

  Reversible splenial lesion syndrome (RESLES) is associated with varied etiologies and typically presents with various clinical features and neurological symptoms. We present an acute myeloid leukemia (AML) patient who was diagnosed as having RESLES by a brain MRI screening in spite of no clear symptom. This previously healthy 15-year-old girl presented with dizziness upon standing for the past 9 days and fatigue while standing for the past 5 days. On admission, her consciousness was clear, and there was no abnormal neurological finding. She was diagnosed with AML, because she had anemia and infiltration of 1% blast cells in the peripheral blood. There were no leukemic cells in the cerebrospinal fluid. Antibiotics and antifungal agents were immediately administered, and she underwent transfusion for anemia. She had a transient fever of 37.5-38℃ on the first and second days of admission during the blood transfusion. Post-treatment, her symptoms of dizziness and fatigue improved. On the eighth day of admission, brain MRI revealed hyperintensity on diffusion-weighted imaging in the splenium of the corpus callosum. Follow-up MRI revealed resolution of the splenium lesion. From the clinical course of malignancies, such as AML, various causes, such as blood transfusion, CNS infiltration, medication, and infections due to immunosuppression, can be assumed. In this case, blood transfusion may have been the etiologic factor for RESLES after a detailed consideration of the clinical course and the period of transient fever due to blood transfusion up until MRI revealed the splenial lesion. Therefore, it is necessary to carefully monitor the clinical course of such patients.