Abstract
Introduction: Acute promyelocytic leukemia (APL) relapse rarely presents with otologic manifestations. Facial nerve palsy associated with external auditory canal (EAC) lesions may mimic benign conditions such as cholesteatoma, leading to diagnostic delay.
Case report: We report the case of a 23-year-old male with a history of recurrent right peripheral facial nerve palsy and acute myeloid leukemia (AML M3) in remission for six years. He presented with a new episode of facial palsy associated with acute conductive hearing loss. Otoscopic examination revealed a bleeding, polypoid mass filling the EAC. Imaging suggested cholesteatoma with bone erosion and facial canal dehiscence. However, during hospitalization, systemic symptoms prompted hematological evaluation, revealing a relapse of APL with 70% promyelocytic blasts and PML-RARA positivity. Following induction chemotherapy, a marked regression of otologic lesions was observed.
Discussion: This case highlights an infrequent presenting symptom of AML relapse and a rare cause of recurrent facial nerve palsy. Leukemic infiltration may closely mimic cholesteatoma but requires no surgery: targeted induction therapy led to regression of the lesion and improvement of the facial palsy, while early control of the coagulopathy was potentially life-saving. Finally, recurrent facial palsy with atypical otologic findings warrants a hematological workup, particularly in patients with a history of leukemia.
Keywords: Acute myeloid leukemia; Recurrent facial palsy; Extramedullary relapse; Temporal bone involvement.
