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Case report: An unusual presentation of acute promyelocytic leukemia in a middle aged female mimicking dengue infection.
Medicine (Baltimore). 2020 Jun 26; 99(26):e21011.M

Abstract

RATIONALE

Acute promyelocytic leukemia (APL) is an uncommon subtype of acute myeloid leukemia (AML). M3v phenotype is a less common presentation of APL and these patients usually present with leukocytosis and abnormal promyelocytes that are characterized by sparse granulation and are less likely to have faggot cells with multiple Auer rods. Distinguishing M3v phenotype from acute febrile illness can be challenging as the diagnosis relies on examination of peripheral smear.

PATIENT CONCERNS

Fifty-seven-year-old female who presented after recent trip to Dominican Republic for high grade fever and gum bleeding. She was exposed to patients with Dengue fever during her stay. At presentation, patient had leukocytosis, thrombocytopenia, and urinalysis showing bacteria and white cell. She was started on treatment for urinary tract infection. Patient remained febrile and thrombocytopenia worsened. On day 2, flow cytometry of the peripheral smear showed 43% medium sized blasts. Fluorescence in situ hybridization was positive for promyelocytic leukemia/retinoic acid receptor alpha.

DIAGNOSES

The patient was diagnosed with APL.

INTERVENTIONS

Patient was started on treatment with all-trans retinoic acid and arsenic trioxide along with supportive care OUTCOMES:: Patient had a favorable clinical response and her symptoms subsided.

LESSONS

Flow cytometry of the peripheral smear is key to diagnosis of suspected APL. One must maintain high suspicion for this life-threatening condition as early diagnosis saves lives.

Authors+Show Affiliations

Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY.Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY.Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY.American University of the Caribbean, Jordan Dr, Sint Maarten, FL.Division of Hematology, Department of Medicine, Bronx Care Health System, Affiliated With Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY.Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, Affiliated With Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32590818

Citation

Yapor, Laura, et al. "Case Report: an Unusual Presentation of Acute Promyelocytic Leukemia in a Middle Aged Female Mimicking Dengue Infection." Medicine, vol. 99, no. 26, 2020, pp. e21011.
Yapor L, Zahid M, Shrestha N, et al. Case report: An unusual presentation of acute promyelocytic leukemia in a middle aged female mimicking dengue infection. Medicine (Baltimore). 2020;99(26):e21011.
Yapor, L., Zahid, M., Shrestha, N., Walck, R., Schreiber, Z., & Adrish, M. (2020). Case report: An unusual presentation of acute promyelocytic leukemia in a middle aged female mimicking dengue infection. Medicine, 99(26), e21011. https://doi.org/10.1097/MD.0000000000021011
Yapor L, et al. Case Report: an Unusual Presentation of Acute Promyelocytic Leukemia in a Middle Aged Female Mimicking Dengue Infection. Medicine (Baltimore). 2020 Jun 26;99(26):e21011. PubMed PMID: 32590818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case report: An unusual presentation of acute promyelocytic leukemia in a middle aged female mimicking dengue infection. AU - Yapor,Laura, AU - Zahid,Maleeha, AU - Shrestha,Nikee, AU - Walck,Randee, AU - Schreiber,Zwi, AU - Adrish,Muhammad, PY - 2020/6/27/entrez PY - 2020/6/27/pubmed PY - 2020/7/8/medline SP - e21011 EP - e21011 JF - Medicine JO - Medicine (Baltimore) VL - 99 IS - 26 N2 - RATIONALE: Acute promyelocytic leukemia (APL) is an uncommon subtype of acute myeloid leukemia (AML). M3v phenotype is a less common presentation of APL and these patients usually present with leukocytosis and abnormal promyelocytes that are characterized by sparse granulation and are less likely to have faggot cells with multiple Auer rods. Distinguishing M3v phenotype from acute febrile illness can be challenging as the diagnosis relies on examination of peripheral smear. PATIENT CONCERNS: Fifty-seven-year-old female who presented after recent trip to Dominican Republic for high grade fever and gum bleeding. She was exposed to patients with Dengue fever during her stay. At presentation, patient had leukocytosis, thrombocytopenia, and urinalysis showing bacteria and white cell. She was started on treatment for urinary tract infection. Patient remained febrile and thrombocytopenia worsened. On day 2, flow cytometry of the peripheral smear showed 43% medium sized blasts. Fluorescence in situ hybridization was positive for promyelocytic leukemia/retinoic acid receptor alpha. DIAGNOSES: The patient was diagnosed with APL. INTERVENTIONS: Patient was started on treatment with all-trans retinoic acid and arsenic trioxide along with supportive care OUTCOMES:: Patient had a favorable clinical response and her symptoms subsided. LESSONS: Flow cytometry of the peripheral smear is key to diagnosis of suspected APL. One must maintain high suspicion for this life-threatening condition as early diagnosis saves lives. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/32590818/Case_report:_An_unusual_presentation_of_acute_promyelocytic_leukemia_in_a_middle_aged_female_mimicking_dengue_infection L2 - https://doi.org/10.1097/MD.0000000000021011 DB - PRIME DP - Unbound Medicine ER -