Peddi Kanksha, Wiggins Brandon, Choudhury Omar, Reulbach Casey, Adams Paul
Internal Medicine, Ascension Genesys Hospital, Grand Blanc, USA.
Neurology, Henry Ford Health System, Detroit, USA.
Cureus. 2022 Mar 17;14(3):e23252. doi: 10.7759/cureus.23252. eCollection 2022 Mar.
Acute promyelocytic leukemia (APL) typically presents with complications from pancytopenia, generalized weakness, and hemorrhagic findings, with a distinguishing feature being the associated predilection of disseminated intravascular coagulation (DIC). APL is characterized by the halting of cellular differentiation in the promyelocyte stage, and balanced chromosomal translocation t(15;17) (q24;q21) that forms the promyelocytic leukemia-retinoic acid receptor-α (PML-RARA) fusion protein present in 95% of cases. APL has a high rate of early mortality secondary to coagulopathy, lending to the imperative need to begin a differentiation agent as soon as the disease is suspected, with all-trans retinoic acid (ATRA) being the most common differentiation agent. Herein, we present the case of a 32-year-old man presenting with non-specific symptoms of fatigue and scattered bruising, who was found to have an intracranial hemorrhage (ICH) in the setting of suspected APL. This case illuminates the importance of early brain imaging in suspected cases of APL to conceivably lessen the severity of hemorrhagic complications and represents a cautionary tale for similar cases in the future.
急性早幼粒细胞白血病（APL）通常表现为全血细胞减少、全身乏力和出血相关的并发症，其一个显著特征是易并发弥散性血管内凝血（DIC）。APL的特点是早幼粒细胞阶段细胞分化停滞，以及95%的病例中存在平衡染色体易位t(15;17)(q24;q21)，形成早幼粒细胞白血病-维甲酸受体-α（PML-RARA）融合蛋白。APL因凝血病导致早期死亡率较高，因此一旦怀疑该病，就迫切需要尽快开始使用分化剂，全反式维甲酸（ATRA）是最常用的分化剂。在此，我们报告一例32岁男性病例，该患者出现疲劳和散在瘀斑等非特异性症状，在疑似APL的情况下发生了颅内出血（ICH）。该病例阐明了在疑似APL病例中早期进行脑部成像的重要性，这可能会减轻出血并发症的严重程度，并为未来类似病例提供警示。
