1Professor, PG Department of Medicine, IMS and SUM Hospital,
2Assistant Professor, PG Department of Medicine, IMS and SUM Hospital,
3Professor, PG Department of Psychiatry, IMS and SUM Hospital,
4Associate Professor, Department of Clinical Hematology and Stem cell transplant
5Junior Resident, PG Department of Medicine, IMS and SUM Hospital
We report a case of a 52-year old male who presented with acute onset psychosis without any systemic symptoms or signs, with normal routine blood biochemistry, peripheral smear and radiological imaging of the brain. Diagnostic lumbar puncture and Flow cytometry of CSF revealed evidence of B-cell Acute Lymphoblastic Leukemia with 44.2% blast cells. Further workup with bone marrow examination was surprisingly normal. PET-CT did not reveal evidence of any malignancy in any organ system other than CNS. B-ALL presentation limited to CNS is rare, and with sole psychiatric manifestation without any focal neurological deficits, meningeal and or systemic signs is even rarer. This case will definitely widen the scope of differential diagnosis of a case of acute-onset psychiatric symptoms in middle to late age.
CNS limited B cell ALL, Psychosis, flow cytometry
