PMID: 18717148Aug 23, 2008Paper

An unusual case of febrile neutropenia: acute myeloid leukemia presenting as myeloid sarcoma of the spleen

Journal of the National Medical Association
Wei-Liang ChenYu-Tzu Tsao

Abstract

Differential diagnosis of a focal splenic lesion in the context of acute leukemia is quite challenging. A 58-year-old woman presented with a 3-day history of fever and abdominal pain. The results of hematological work-up were consistent with acute myeloblastic leukemia (M2, French-American-British classification). Being susceptible to infection in this leukemic patient with severe neutropenia, a diagnosis of splenic abscess was straightforward, plausibly supported by the radiographic findings. Despite empiric broad-spectrum antibiotic treatment, hyperleukocytosis with resultant pulmonary leukostasis supervened. Histological sections from ultrasound-guided percutaneous core-needle biopsy of the spleen confirmed the diagnosis of myeloid sarcoma. However, delayed leukemia-targeted therapy, unfortunately, resulted in catastrophic mortality. It should be addressed that, even with the advent of modern imaging modalities, there can be a diagnostic pitfall when managing solitary splenic lesion in acute leukemic patients without histological examination. Early recognition with prompt chemotherapeutic intervention can be life saving.

Citations

Jan 26, 2017·Journal of Pediatric Hematology/oncology·Yueli RaoJie Yan

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