CC BY-NC-ND 4.0 · Avicenna J Med 2015; 05(04): 131-133
DOI: 10.4103/2231-0770.165125
CASE REPORT

Acute promyelocytic leukemia presenting as pulmonary thromboembolism: Not all APLs bleed

Ashok K Vaid
Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India
,
Sandeep Batra
Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India
,
Suman S Karanth
Department of Medical Oncology, Medanta, The Medicity, Gurgaon, Haryana, India
,
Sachin Gupta
Department of Medical Oncology, Max Superspeciality Hospital, Mohali, Punjab, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

We present a rare case of acute promyelocytic leukemia (APL) presenting as pulmonary thromboembolism being misdiagnosed as community.acquired pneumonia. Thrombotic phenomenon in APL are poorly understood and grossly underreported. In our case, following no response to standard antibiotic treatment, the patient was further investigated and detected to have an acute pulmonary thromboembolism following right lower limb deep vein thrombosis (DVT). Though, complete blood picture revealed only mild hyperleukocytosis, bone marrow biopsy and aspiration revealed 60% blasts and a positive t (15,17)(q22,12) and PML retinoic acid receptor alpha (RARA) fusion protein on molecular cytogenetics. He was diagnosed as APL and received treatment with all.transretinoic acid (ATRA) and arsenic trioxide (ATO) and therapeutic anticoagulation



Publication History

Article published online:
09 August 2021

© 2015. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 
  • References

  • 1 Jaffe ES, Harris NL, Stein H, Vardiman JW, editors. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Vol. 3. Lyon: IARC Press; 2001.
  • 2 Sanz MA, Montesinos P. Open issues on bleeding and thrombosis in acute promyelocytic leukemia. Thromb Res 2010;125:S51-4.
  • 3 Yamamoto JF, Goodman MT. Patterns of leukemia incidence in the United States by subtype and demographic characteristics, 1997-2002. Cancer Causes Control 2008;19:379-90.
  • 4 Lo-Coco F, Avvisati G, Vignetti M, Thiede C, Orlando SM, Iacobelli S, et al.; German-Austrian Acute Myeloid Leukemia Study Group; Study Alliance Leukemia. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med 2013;369:111-21.
  • 5 Falanga A, Russo L, Tartari CJ. Pathogenesis and treatment of thrombohemorrhagic diathesis in acute promyelocytic leukemia. Mediterr J Hematol Infect Dis 2011;3:e2011068.
  • 6 Falanga A, Alessio MG, Donati MB, Barbui T. A new procoagulant in acute leukemia. Blood 1988;71:870-5.
  • 7 Breccia M, Avvisati G, Latagliata R, Carmosino I, Guarini A, De Propris MS, et al. Occurrence of thrombotic events in acute promyelocytic leukemia correlates with consistent immunophenotypic and molecular features. Leukemia 2007;21:79-83.
  • 8 Rashidi A, Silverberg ML, Conkling PR, Fisher SI. Thrombosis in acute promyelocytic leukemia. Thromb Res 2013;131:281-9.