title: Acute myocardial infarction as the presenting symptom of acute myeloblastic leukemia with extreme hyperleukocytosis.
abstract: This case report deals with an unusual leukostatic complication in a 56-year-old woman with acute myeloblastic leukemia (AML) and extreme hyperleukocytosis (316 x 10(9)/L) who presented with acute myocardial infarction (MI). After leukopheresis the patient achieved hemodynamic stabilization and rapid neurologic recovery of encephalopathy that had also developed after the infarction. Considering the central role of WBC in the remodeling of post MI myocardial tissue, it was obvious that administration of chemotherapy with its subsequent inevitable pancytopenia could impose an increased risk for further cardiac complications including myocardial rupture. Nevertheless, cytarabine-based induction chemotherapy was initiated 3 days after admission, and she achieved prolonged complete remission. Coronary angiography disclosed segmental atherosclerosis, but the only significant obstruction was in the right coronary artery. The patient died with relapsed leukemia 7 years later without recurrence of any cardiac symptoms or signs. Autopsy disclosed segmental coronary atherosclerosis involving the LAD (60% obstruction), suggesting that atherosclerosis was a predisposing risk factor. Additional compromise to blood perfusion due to leukostasis had led to this unusual complication of AML involving a major vessel. This is the first documented case of leukostasis causing coronary artery occlusion as well as the first report of successful induction chemotherapy for AML during a myocardial infarction.
authors.affiliation: Department of Hematology, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Cohen
authors.forename: Gail
authors.initials: G
authors.lastname: Amir
authors.forename: Nael
authors.initials: N
authors.lastname: Da'as
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gillis
authors.forename: Deborah
authors.initials: D
authors.lastname: Rund
authors.forename: Aaron
authors.initials: A
authors.lastname: Polliack
mesh_terms: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D015703:Antigens, CD / Q000276:immunology; D015214:Antigens, Differentiation, Myelomonocytic / Q000276:immunology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003221:Confusion / Q000209:etiology / Q000628:therapy; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D000079982:Gemtuzumab; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D007167:Immunotherapy; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D007964:Leukocytosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009203:Myocardial Infarction / Q000209:etiology*; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy; D063268:Sialic Acid Binding Ig-like Lectin 3; D013812:Therapeutics; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; C571163:CD33 protein, human; D063268:Sialic Acid Binding Ig-like Lectin 3; D003561:Cytarabine; D005047:Etoposide; D000079982:Gemtuzumab; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine; D015255:Idarubicin