title: Myocardial infarction and stroke as the presenting symptoms of acute myeloid leukemia.
abstract: BACKGROUND
  Hyperleukocytosis in acute leukemia is associated with lymphadenopathy, hepatosplenomegaly, disseminated intravascular coagulation, and central nervous system complications. Patients with hyperleukocytosis have lower complete remission rates and have a higher mortality rate, primarily from intracranial hemorrhage.
  
  
  OBJECTIVE
  To present the potential complications from extreme leukocytosis.
  
  
  METHODS
  A 76-year-old man presented to the Emergency Department with chest pain, right-sided weakness, and decreased responsiveness. He was diagnosed with both an acute stroke and myocardial infarction due to extreme leukocytosis from acute myeloid leukemia. Each of these complications by itself would be an unusual manifestation of hyperleukocytosis. To the best of the author's knowledge, this represents the first reported case of these two complications simultaneously from extreme leukocytosis.
  
  
  CONCLUSIONS
  Patients with acute leukemia may present with hyperleukocytosis, which may result in decreased tissue perfusion. Ischemia occurring in the heart can lead to an acute myocardial infarction, whereas ischemia in the brain can lead to a stroke. These events may, on occasion, be the initial presentation of leukemia. Rapid identification and treatment of the hyperleukocytosis may prevent these complications.
authors.affiliation: Department of Emergency Medicine and Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Muñiz
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology*; D020521:Stroke / Q000209:etiology*