Background: Epidural involvement in non-Hodgkin’s lymphoma is not a classical presentation. Limited cases were reported with B-lineage Lymphoblastic Lymphoma (B-LBL). Patients develop an acute onset of neurological symptoms preceded by vague back pain. Case presentation: A 6 years old male presented with unsteady gait and bilateral foot numbness for 3 days. Acute onset of paraplegia was noticed after 2 days from admission. MRI showed large anterior paravertebral and posterior mediastinal soft tissue mass at thoracic spine causing severe spinal cord compression. The patient underwent decompressive laminectomy and received chemotherapy as per the protocol of AALL0232. Two months follow up patient exhibited partial neurological recovery. Conclusion: Vague back pain or gait disturbance, hence posterior spinal column functional disturbance, full neurological examination, and medical imaging must be carried on without delay. Once a space occupation lesion with a progressive neurological deficit is identified, urgent surgical management must be undertaken to preserve remaining function and aid for the best functional recovery.
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