Successful Management of Acute Promyelocytic Leukemia in a Patient Who Presented With Acute Ischemic Stroke on Top of Subdural Hematoma.

Autor:	Mallah S; Department of Internal Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE., Owda F; Department of Internal Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE., Hamayel H; Department of Internal Medicine, An-Najah National University Hospital, Nablus, PSE., Enaya A; Department of Internal Medicine, An-Najah National University Hospital, Nablus, PSE., Mallah O; Department of Radiology, An-Najah National University Hospital, Nablus, PSE., Abugaber D; Department of Internal Medicine, An-Najah National University Hospital, Nablus, PSE.; Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE., Odeh R; Department of Hemato-oncology, An-Najah National University Hospital, Nablus, PSE.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2023 Sep 14; Vol. 15 (9), pp. e45243. Date of Electronic Publication: 2023 Sep 14 (Print Publication: 2023).
DOI:	10.7759/cureus.45243
Abstrakt:	Acute promyelocytic leukemia (APL), a distinct subtype of acute myelogenous leukemia (AML), is commonly associated with a heightened risk of bleeding due to coagulopathy. Thrombotic events, although less frequent, have also been linked to APL. However, the occurrence of ischemic stroke as an initial presentation of APL, particularly concomitant with central nervous system (CNS) bleeding, is exceedingly rare. The combination of these two complications is not reported in APL patients and is anticipated to carry a high mortality rate even with treatment. In this report, we describe the case of a young female patient with no significant medical history, who presented with decreased consciousness and recurrent seizures. Brain magnetic resonance imaging (MRI) revealed the simultaneous occurrence of acute ischemic stroke and acute-on-chronic subdural hematoma. The subsequent bone marrow biopsy confirmed the diagnosis of APL, displaying the characteristic positive promyelocytic leukemia (PML)-retinoic acid receptor alpha (RARA) t(15;17) translocation. The patient was promptly initiated on a high-risk AML-M3 protocol, coupled with supportive treatment through platelet transfusion. Remarkably, a favorable response to treatment was observed, and a marked improvement in her neurological parameters was observed within 2 weeks duration of treatment. Subsequent assessment through a bone marrow biopsy one month later revealed complete remission, with the PML-RARA fusion gene becoming negative following a single course of consolidation therapy. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Mallah et al.)
Databáze:	MEDLINE
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