Case report: a critically ill patient with aggressive NK-cell leukemia receiving emergency chemotherapy in the ICU.

Aggressive NK-cell leukemia (ANKL) is a scarce mature NK-cell neoplasm frequently associated with Epstein-Barr virus (EBV) infection. We report the case of a 47-year-old male patient who was admitted to the hospital due to recurrent fever, jaundice, and dyspnea, and was diagnosed with ANKL accompanied by multi-organ failure. Upon transfer to the intensive care unit (ICU), he received emergency chemotherapy consisting of etoposide, pegaspargase, and gemcitabine, in conjunction with organ support therapies including DPMAS, LPE, and CVVHD. Subsequently, the patient’s condition stabilized, and he was discharged. However, following the second cycle of chemotherapy, he was readmitted due to altered mental status. Due to financial constraints, the family decided not to pursue further treatment, leading to the patient’s eventual demise. Overall, this case highlights the critical importance of multidisciplinary collaboration for managing critically ill ANKL patients. Careful evaluation of the risks associated with chemotherapy, combined with timely administration of emergency chemotherapy in the ICU and comprehensive multi-organ support, can potentially offer a survival opportunity.