An unusual case of febrile neutropenia: acute myeloid leukemia presenting as myeloid sarcoma of the spleen.
Differential diagnosis of a focal splenic lesion in the context of acute leukemia is quite challenging. A 58-year-old woman presented with a 3-day history of fever and abdominal pain. The results of hematological work-up were consistent with acute myeloblastic leukemia (M2, French-American-British classification). Being susceptible to infection in this leukemic patient with severe neutropenia, a diagnosis of splenic abscess was straightforward, plausibly supported by the radiographic findings. Despite empiric broad-spectrum antibiotic treatment, hyperleukocytosis with resultant pulmonary leukostasis supervened. Histological sections from ultrasound-guided percutaneous core-needle biopsy of the spleen confirmed the diagnosis of myeloid sarcoma. However, delayed leukemia-targeted therapy, unfortunately, resulted in catastrophic mortality. It should be addressed that, even with the advent of modern imaging modalities, there can be a diagnostic pitfall when managing solitary splenic lesion in acute leukemic patients without histological examination. Early recognition with prompt chemotherapeutic intervention can be life saving.
Chen
Wei-Liang
WL
Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
Hsu
Yu-Juei
YJ
Tsai
Wei-Chi
WC
Tsao
Yu-Tzu
YT
D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology*; D023981:Sarcoma, Myeloid / Q000150:complications / Q000175:diagnosis*; D013154:Spleen / Q000473:pathology; D013160:Splenic Neoplasms / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed