Case of epileptic seizure because of bone metastasis of chronic lymphoid leukaemia and Merkel cell carcinoma in 62-year-old female patient.
This article highlights the case of a 62-year-old female patient with epileptic seizure provoked by bone metastasis of chronic lymphoid leukaemia and Merkel cell carcinoma. The patient was diagnosed with chronic lymphoid leukaemia 10 years ago. The patient’s medical history revealed that he underwent a laparoscopic cholecystectomy in 2006.
2 years ago, a lesion that resembled an atheroma was removed from the right upper arm of the patient. Histology and immunohistochemistry of the patient was consistent with the diagnosis of Merkel cell carcinoma (MCC). The patient was suggested chemotherapy based on National Comprehensive Cancer Network (NCCN) guidelines. However, the treatment had to be discontinued because of bone marrow depression. The lesion had to be reoperated 7 months later because the lesion recurred. The local recurrence of MCC and its metastasis in the axillary lymph node required right axillary block dissection. Aspiration cytology confirmed lymph nodes metastasis from both CLL and MCC.
Treatment included postoperative radiotherapy. However, the patient’s condition continued to deteriorate. Metastases from MCC was evident through the right axillary soft tissue conglomerate mass infiltrating the the right lateral thoracic wall. In addition to the parasternal and mediastinal lymph nodes appearance. The clinical progression required chemotherapy to be reinitiated.
The patient was admitted to the neurology department 3 days after chemotherapy after her first epileptic seizure. She also complained of headaches during and before admission. The bone metastasis was ruled out to be the cause of her epileptic seizure. Merkel cell carcinoma is a rare neuroendocrine tumour that rarely metastasises to the brain. Whereas chronic lymphoid leukaemia is a predisposing factor of MCC. In this case, the headache and epileptic seizure suggested metastasis of the disease to the brain.
References
Epileptic Seizure Provoked by Bone Metastasis of Chronic Lymphoid Leukemia and Merkel Cell Carcinoma https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609155/
