Facial nerve palsy as the presenting symptom of acute myeloid leukemia

Acute lymphoblastic leukaemia (ALL) and acute myeloblasticleukaemia (AML) are the most common malignancies diagnosed in children and arise within bone marrow precursors of lymphoid and myeloid lineages. ALL accounts for one fourth of all childhood cancer and approximately 75% of all cases of childhood leukaemia, with an annual incidence of about 30 cases per million people and a peak incidence in children aged 2–5 years. AML comprises approximately 15–20% of childhood leukaemia (Pui, 2004). Facial palsy is an acute, peripheral, lower motor neuron facial nerve paralysis with a usually favourable prognosis. Its causes are unknown, although it appears to be a polyneuritis with possible infectious, inflammatory, autoimmune and metabolic aetiologies. In addition, facial palsy is an unusual presentation of leukaemia and other lymphoid and myeloid malignancies where facial neuritis has secondary involvement (Löwenberg et al., 1999). Facial paralysis in children is very often idiopathic and isolated facial nerve palsy, resulting from leukemic infiltration is a rare occurrence. Facial palsy is not well recognized as a presenting symptom of childhood leukemia, especially in acute myeloid leukemia (AML) (Karimi et al., 2009). Here we present the case of a 13 year old boy with acute myeloid leukemia, who first presented with isolated right side peripheral facial nerve paralysis. The presence of Bell's palsy in young children requires a complete evaluation, keeping in mind the possibility of leptomeningeal disease. The purpose of reporting this case is to emphasize the need of examining the peripheral blood and bone marrow in children presenting as facial palsy for early diagnosis of childhood AML.