A 63-year-old man with acute myeloid leukemia (AML) and treated with venetoclax and azacytidine, presented to the emergency department with fever, shortness of breath and gum bleeding. Laboratory evaluation showed pancytopenia; prolonged thrombin time with hypofibrinogenemia, elevated D-dimer and hyperferritinemia (29,000 µg/ L). Bone marrow smear revealed blastic infiltration with hemophagocytosis by histiocytes (panel A), macrophages (Panel B) and blasts (Panels C and D), (Figure 1).
Bone marrow aspirate showing hemophagocytosis by (A) histiocytes, (B) macrophages and (C, D) infiltration with hemophagocytosis by monocytic blasts (Wright-Giemsa stain, 100x).
Salvage chemotherapy was initiated, but the patient died 28 days after presentation. Hemophagocytic lymphohistiocytosis can be diagnosed in up to 10% of patients with AML,11 Delavigne K., Bérard E., Bertoli S., Corre J., Duchayne E., Demur C., et al. Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy. Haematologica. 2014;99(3):474-80. and is associated with poor outcomes.11 Delavigne K., Bérard E., Bertoli S., Corre J., Duchayne E., Demur C., et al. Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy. Haematologica. 2014;99(3):474-80.,22 Hatano K., Nagai T., Matsuyama T., Sakaguchi Y., Fujiwara S., Oh I., et al. Leukemia cells directly phagocytose blood cells in AML-associated hemophagocytic lymphohistiocytosis: a case report and review of the literature. Acta Haematol. 2015;133(1):98-100.
References
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1Delavigne K., Bérard E., Bertoli S., Corre J., Duchayne E., Demur C., et al. Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy. Haematologica. 2014;99(3):474-80.
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2Hatano K., Nagai T., Matsuyama T., Sakaguchi Y., Fujiwara S., Oh I., et al. Leukemia cells directly phagocytose blood cells in AML-associated hemophagocytic lymphohistiocytosis: a case report and review of the literature. Acta Haematol. 2015;133(1):98-100.
Publication Dates
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Publication in this collection
27 May 2024 -
Date of issue
Jan-Mar 2024
History
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Received
14 Aug 2023 -
Accepted
24 Aug 2023 -
Published
14 Sept 2023