Spinal myeloid sarcoma as a first sign of acute myeloid leukaemia: A case report

Myeloid sarcomas, also called granulocytic sarcomas or chloromas, are rare extramedullary tumours of immature myeloid cells, most often associated with acute myeloid leukaemia (AML). Spinal involvement is particularly uncommon and typically manifests with neurological symptoms due to nerve compression. We report a 58-year-old male with right lumbar pain radiating to the foot and intermittent paraesthesia. MRI revealed an extramedullary spinal mass compressing the right L5 nerve root and infiltrating the L5 vertebral body, with confirming the diagnosis of AML. PET-CT and follow-up MRI demonstrated extensive paraspinal and spinal canal infiltration. The patient initially developed rapid neurological decline with impaired gait and reflexes despite treatment, though subsequent combined systemic and intrathecal chemotherapy achieved partial regression in size and complete metabolic activity. The patient is currently planned for radiotherapy and stem cell transplantation. Spinal myeloid sarcomas are rare but clinically significant in patients with myeloid malignancies presenting with neurological deficits. MRI is the preferred imaging modality, but histopathology remains essential for diagnosis. Management generally requires systemic chemotherapy, with radiotherapy as adjunctive therapy. Prognosis remains guarded, particularly in cases complicated by spinal cord compression. Myeloid sarcoma should be considered in the differential diagnosis of spinal masses in AML. Early recognition and aggressive treatment resulted in a favourable outcome for our patient.