An 82-year-old woman was admitted to our hospital presenting with febrile neutropenia. She had been diagnosed with chronic myeloid leukemia 2 years ago and had been on imatinib treatment since [1]. A month before admission she presented with malaise, anemia, and mild leukopenia; a bone marrow aspirate and biopsy performed 20 days before admission showed no alterations. Imatinib dosing was adjusted but mild cytopenia persisted. The patient presented with acute abdominal pain, fever, and shaking chills to the emergency department. On physical examination the patient was awake and appeared uncomfortable. She had pain in the left lower abdominal quadrant. Petechiae were evident on the lower limbs. Complete blood count revealed anemia, severe neutropenia, and thrombocytopenia (Table 1). Overt disseminated intravascular coagulation was present. Abdominal computed tomography showed acute diverticulitis. The patient was started on broad-spectrum antibiotics. Informed consent was obtained.
Table 1. Results of laboratory testing.
A peripheral blood smear revealed more than 30% circulating promyelocytic blasts. A bone marrow aspirate and biopsy showed hypercellular marrow with myeloid hyperplasia and more than 90% myeloblasts (Figure 1). The blasts displayed hypergranular cytoplasm with bundles of Auer rods. PML/RAR-α was positive according to real-time PCR of the bone marrow. A diagnosis of promyelocytic blastic crisis was made [2,3,4,5].
Figure 1. Leukemic cell morphology of bone marrow aspiration specimen (May-Grünwald-Giemsa).
Footnotes
Conflict of Interest Statement
The author of this paper has no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included.
References
- 1.Faderl S, Talpaz M, Estrov Z, O’Brien S, Kurzrock R, Kantarjian HM. The biology of chronic myeloid leukemia. N Engl J Med. 1999;341:164–172. doi: 10.1056/NEJM199907153410306. [DOI] [PubMed] [Google Scholar]
- 2.Calabretta B, Perrotti D. The biology of CML blast crisis. Blood. 2004;103:4010–4022. doi: 10.1182/blood-2003-12-4111. [DOI] [PubMed] [Google Scholar]
- 3.Shichishima T, Abe R, Satoh T, Kawaguchi M, Uchida T, Kariyone S. Promyelocytic crisis of chronic myelocytic leukemia: case report and review of the literature. Nihon Ketsueki Gakkai Zasshi. 1987;50:1190–1195. [PubMed] [Google Scholar]
- 4.Abe R, Shichishima T, Kawaguchi M, Uchida T, Kariyone S. Promyelocytic crisis of chronic myelogenous leukemia without t(15;17) Cancer Genet Cytogenet. 1986;21:175–179. doi: 10.1016/0165-4608(86)90044-0. [DOI] [PubMed] [Google Scholar]
- 5.Gozzetti A, Bocchia M, Calabrese S, Pirrotta MT, Crupi R, Raspadori D, Lauria F. Promyelocytic blast crisis of chronic myelogenous leukemia during imatinib treatment. Acta Haematol. 2007;117:236–237. doi: 10.1159/000099548. [DOI] [PubMed] [Google Scholar]