Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient

Background. Extramedullary hematopoiesis (EMH) is one of the rare causes of spinal cord compression (SCC). It results from noncancerous proliferation of hematopoietic tissue outside the bone marrow as a compensatory mechanism for ineffective erythropoiesis. It occurs in the paraspinal area in 11–15%...

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Main Authors: Ismail Ibrahim Ismail, Fathi Massoud, K. J. Alexander, Jasem Youssef Al-Hashel
Format: Article
Language:English
Published: Wiley 2019-01-01
Series:Case Reports in Neurological Medicine
Online Access:http://dx.doi.org/10.1155/2019/5827626
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author Ismail Ibrahim Ismail
Fathi Massoud
K. J. Alexander
Jasem Youssef Al-Hashel
author_facet Ismail Ibrahim Ismail
Fathi Massoud
K. J. Alexander
Jasem Youssef Al-Hashel
author_sort Ismail Ibrahim Ismail
collection DOAJ
description Background. Extramedullary hematopoiesis (EMH) is one of the rare causes of spinal cord compression (SCC). It results from noncancerous proliferation of hematopoietic tissue outside the bone marrow as a compensatory mechanism for ineffective erythropoiesis. It occurs in the paraspinal area in 11–15% of thalassemic patients in intermediate and severe cases causing a paraspinal compressive mass. We present a rare case of spinal EMH with thoracic cord compression in a 22-year-old female with beta thalassemia who presented with paraparesis and we provide a review of literature. Case Report. A 22-year-old female patient with a known history of beta thalassemia presented with subacute onset of weakness and numbness of both lower limbs with a sensory level at T6. Magnetic resonance imaging (MRI) of the dorsal spine showed cord compression secondary to paraspinal EMH from T2 to T9 with most prominent compression over T5. She was managed with blood transfusion and low-dose radiotherapy. Conclusion. Although rare, EMH should be suspected in thalassemic patients presenting with paraplegia. Treatment with blood transfusions is usually effective. Other options include radiotherapy, surgery, hydroxyurea or a combination of these modalities.
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spelling doaj-art-0c55fc77740a471684a799d90eb76cde2025-08-20T02:02:55ZengWileyCase Reports in Neurological Medicine2090-66682090-66762019-01-01201910.1155/2019/58276265827626Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic PatientIsmail Ibrahim Ismail0Fathi Massoud1K. J. Alexander2Jasem Youssef Al-Hashel3Department of Neurology, Ibn Sina Hospital, KuwaitDepartment of Neurology, Ibn Sina Hospital, KuwaitDepartment of Neurology, Ibn Sina Hospital, KuwaitDepartment of Neurology, Ibn Sina Hospital, KuwaitBackground. Extramedullary hematopoiesis (EMH) is one of the rare causes of spinal cord compression (SCC). It results from noncancerous proliferation of hematopoietic tissue outside the bone marrow as a compensatory mechanism for ineffective erythropoiesis. It occurs in the paraspinal area in 11–15% of thalassemic patients in intermediate and severe cases causing a paraspinal compressive mass. We present a rare case of spinal EMH with thoracic cord compression in a 22-year-old female with beta thalassemia who presented with paraparesis and we provide a review of literature. Case Report. A 22-year-old female patient with a known history of beta thalassemia presented with subacute onset of weakness and numbness of both lower limbs with a sensory level at T6. Magnetic resonance imaging (MRI) of the dorsal spine showed cord compression secondary to paraspinal EMH from T2 to T9 with most prominent compression over T5. She was managed with blood transfusion and low-dose radiotherapy. Conclusion. Although rare, EMH should be suspected in thalassemic patients presenting with paraplegia. Treatment with blood transfusions is usually effective. Other options include radiotherapy, surgery, hydroxyurea or a combination of these modalities.http://dx.doi.org/10.1155/2019/5827626
spellingShingle Ismail Ibrahim Ismail
Fathi Massoud
K. J. Alexander
Jasem Youssef Al-Hashel
Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient
Case Reports in Neurological Medicine
title Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient
title_full Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient
title_fullStr Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient
title_full_unstemmed Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient
title_short Compressive Dorsal Myelopathy Secondary to Extramedullary Hematopoiesis in a Thalassemic Patient
title_sort compressive dorsal myelopathy secondary to extramedullary hematopoiesis in a thalassemic patient
url http://dx.doi.org/10.1155/2019/5827626
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