Case history
Case history
A 58-year-old man presents to his primary care physician with increasing tiredness, accompanied by bruising on his legs. He also complains of aching bones. He has no recent history of illness. On examination, he is pyrexial and pale, has bony tenderness over the sternum and tibia, and has petechiae on his legs. There are no palpable lymph nodes. He has crepitations at the left base. The liver and spleen are not palpable.
Other presentations
Other presentations include dizziness, palpitations, and dyspnoea, due to anaemia. Severe infection and fever may be present due to neutropenia. Mucosal bleeding and ecchymoses may be present due to thrombocytopenia.
Coagulopathies are reasonably common with AML, and disseminated intravascular coagulation (DIC) is common with acute promyelocytic leukaemia (APL).
Patients may present with features of extramedullary infiltration, such as hepatosplenomegaly or lymphadenopathy. Less commonly, patients present with gingival enlargement, testicular masses, skin chloromas, cutaneous ulcers, and/or symptoms of meningeal leukaemic infiltration (e.g., headache, confusion).
Pulmonary symptoms (e.g., dyspnoea) and gastrointestinal symptoms (e.g., severe abdominal pain) due to leukaemic infiltration or infection may be present.
An elevated white blood cell count >100 × 10⁹/L (>100,000/microlitre; hyperleukocytosis) occurs in approximately 5% to 20% of patients with AML, predisposing them to complications such as tumour lysis syndrome, central nervous system involvement, and leukostasis (symptomatic hyperleukocytosis; symptoms include respiratory distress and altered mental status).[3][4] These are medical emergencies and require immediate treatment.
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