Chloroma - A Rare Case of Metastatic Tumor to Dorsal Spine in Patient of Chronic Myeloid Leukemia Causing Acute Paraparesis.

Introduction: Chloromas are defined as metastatic granulocytic solid tumors of myeloid origin occurring at an extramedullary site. In this case report, we present an uncommon case of chronic myeloid leukemia (CML) presenting with metastatic sarcoma to the dorsal spine causing acute paraparesis. Case Report: A 36-year-old male presented in the OPD with complaints of progressive upper back pain and acute paraparesis since a 1 week. The patient is a previously diagnosed case of CML on treatment for the same. MRI of the dorsal spine indicated extradural soft-tissue lesions in D5-D9 extending to the right side of the spinal canal displacing the cord to the left. Considering the acute paraparesis that the patient developed, he was taken for an emergency decompression of the tumor. Microscopy showed infiltration of fibrocartilaginous tissue of polymorphous origin mixed with atypical myeloid precursor cells. Immunohistochemistry reports show atypical cells diffusely expressing myeloperoxidase, focally expressing CD34 and Cd117. Conclusion: Rare case reports like this are the only literature available on remission in CML cases with sarcomas. The acute paraparesis in our patient was prevented from increasing to a paraplegia by surgical means. Immediate decompression of the spinal cord in patients with paraparesis and associated radiotherapy and chemotherapy should be considered in all patients with myeloid sarcomas of CML origin. While examining patients of CML, the possibility of a granulocytic sarcoma should always be kept in mind.

Acute Paraparesis in a Patient after High Velocity Manipulation of Cervical Spine and its Management.

Introduction: In this case report, we question the safety associated with high velocity manipulations of the cervical spine. These procedures do not frequently cause catastrophic adverse effects but few and rare case reports like this make us aware about the possible complications of the maneuvers. Case Report: This case report presents an uncommon presentation of acute neurodeficit to a 57-year-old male following a neck manipulation by a barber in the saloon which recovered partially with Intravenous steroid therapy but required active intervention surgically to treat his complete symptomatology. The magnetic resonance imaging (T2-weighted) showed a high signal intensity within the spinal cord at the C4C5 level (cord edema). Here, we discuss the possible mechanism of injury and the need to educate the lesser common risks of performing such sudden and forceful maneuvers. Conclusion: This case report is a reminder that people should be careful while trying alterative types of therapy which use forceful neck manipulations to relieve pain as this maneuver could cause injuries to the disc complex especially when the patient already has a disc prolapse which is asymptomatic, causing the disc to fail again making it symptomatic.