Acute promyelocytic leukemia presenting as recurrent venous and arterial thrombotic events: a case report and review of the literature. Issue 6 (2nd November 2021)

• Record Type: Journal Article
• Authors: MacDougall, Kira; Chukkalore, Divya; Rehan, Maryam; Kashi, Meena; Bershadskiy, Alexander
• Is Part Of: Journal of community hospital internal medicine perspectives. Volume 11:Issue 6(2021)
• Page Start: 832
• Page End: 838
• Publication Date: 2021-11-02
• Subjects: Acute promyelocytic leukemia -- venous thromboembolism -- splenic infarct -- renal infarct -- ischemic stroke -- all-transretinoic acid; Internal medicine -- Periodicals; Hospitals -- Periodicals; Hospitals, Community; Internal Medicine; Hospitals; Internal medicine; Periodicals; Periodicals; 610
• DOI: 10.1080/20009666.2021.1973657
• Languages: English
• ISSNs: 2000-9666

Abstract

ABSTRACT: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia characterized by a translocation of chromosomes 15 and 17, creating an alternation in the retinoic acid receptor-alpha (RAR-alpha) gene. This leads to excessive medullary production of promyelocytic blasts, which are frequently associated with the hemorrhagic complications seen in APL. In contrast, APL-associated thrombosis occurs much less frequently and is an underappreciated life-threatening manifestation of the disease. Most thrombotic events occur during induction chemotherapy with all-transretinoic acid and are rarely seen as the initial presentation on APL. Here we report an exceedingly rare case of a patient with recurrent venous and arterial thrombotic events, including deep vein thrombosis, bilateral segmental pulmonary embolism, an ischemic stroke, splenic infarcts, and renal infarcts, later found to have APL. We aim to discuss the most recent understanding of the pathogenesis of APL-associated thrombosis and to summarize the literature of this rare presentation of APL.