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A 63-year-old man with acute myeloid leukemia (AML) and treated with venetoclax and azacytidine, presented to the emergency department with fever, shortness of breath and gum bleeding. Laboratory evaluation showed pancytopenia; prolonged thrombin time with hypofibrinogenemia, elevated D-dimer and hyperferritinemia (29,000 µg/ L). Bone marrow smear revealed blastic infiltration with hemophagocytosis by histiocytes (panel A), macrophages (Panel B) and blasts (Panels C and D), (Figure 1).
Salvage chemotherapy was initiated, but the patient died 28 days after presentation. Hemophagocytic lymphohistiocytosis can be diagnosed in up to 10% of patients with AML,1 and is associated with poor outcomes.1,2
References
[1]
K. Delavigne, E. Bérard, S. Bertoli, J. Corre, E. Duchayne, C. Demur, et al.
Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy.
Haematologica, 99 (2014), pp. 474-480
[2]
K. Hatano, T. Nagai, T. Matsuyama, Y. Sakaguchi, S. Fujiwara, I. Oh, et al.
Leukemia cells directly phagocytose blood cells in AML-associated hemophagocytic lymphohistiocytosis: a case report and review of the literature.
Acta Haematol, 133 (2015), pp. 98-100
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