Department of Medicine, St. Joseph's University Medical Center, Paterson, NJ, USA.
Department of Hematology-Oncology, St. Joseph's University Medical Center, Paterson, NJ, USA.
Am J Case Rep. 2023 Feb 10;24:e938086. doi: 10.12659/AJCR.938086.
BACKGROUND Acute promyelocytic leukemia (APL) is a rare subtype of acute myeloid leukemia (AML) and is characterized by a genetic translocation affecting the retinoic acid receptor-alpha gene, leading to blockage in the differentiation of granulocytic cells. The accumulation of promyelocytes in bone marrow leads to cytopenias and life-threatening coagulopathies. Definitive diagnosis is made with bone marrow biopsy. Differentiation of APL from other leukemias is important to appropriately treat with all-trans retinoic acid (ATRA) and arsenic trioxide. Patients with HIV are at a higher risk to develop AML. This article identifies how multiple comorbidities and social factors can contribute to difficulties in diagnosing AML. CASE REPORT We present a 67-year-old man with a past medical history of hypertension and substance use disorder who presented with progressive exertional dyspnea and was found to have HIV, chronic hepatitis C, and APL with pancytopenia. His bone marrow biopsy confirmed AML. This was a case of co-existing HIV and aleukemic leukemia. CONCLUSIONS APL can present with pancytopenia, weakness, failure to thrive, or bleeding complications, which can be similar to presentations of those diagnosed with HIV. Diagnosis of APL can be differentiated between hypergranular and hypogranular; our patient demonstrated APL with only 52% blasts, which can make for a challenging diagnosis. Given increased mortality of APL, immediate ATRA therapy is warranted. Aleukemic leukemia is a rare presentation typically accompanied by skin manifestations. Our case highlights the importance of having high clinical suspicion for malignancy in patients with comorbidities that can interfere with the classic presentation of leukemia.
急性早幼粒细胞白血病（APL）是一种罕见的急性髓系白血病（AML）亚型，其特征是存在影响维甲酸受体-α基因的遗传易位，导致粒细胞分化受阻。骨髓中早幼粒细胞的积累导致血细胞减少和危及生命的凝血功能障碍。明确诊断需要进行骨髓活检。将 APL 与其他白血病区分开来对于用全反式维甲酸（ATRA）和三氧化二砷进行适当治疗很重要。HIV 感染者患 AML 的风险更高。本文确定了多种合并症和社会因素如何导致 AML 诊断困难。
我们介绍了一位 67 岁男性，既往有高血压和药物滥用障碍病史，表现为进行性运动性呼吸困难，被诊断为 HIV、慢性丙型肝炎和 APL 伴全血细胞减少症。他的骨髓活检证实为 AML。这是一例同时存在 HIV 和无白血病性白血病的病例。
APL 可表现为全血细胞减少症、虚弱、生长不良或出血并发症，这些症状与 HIV 感染者的表现相似。APL 可分为高颗粒型和低颗粒型；我们的患者表现为 APL，仅 52%的原始细胞，这可能使诊断具有挑战性。鉴于 APL 的死亡率增加，需要立即进行 ATRA 治疗。无白血病性白血病是一种罕见的表现，通常伴有皮肤表现。我们的病例强调了在患有可能干扰白血病典型表现的合并症的患者中，对恶性肿瘤具有高度临床怀疑的重要性。
