Although rare, extramedullary involvement can be observed in patients with acute myeloid leukemia (AML). These extramedullary involvements are also known as myeloid sarcoma, granulocytic sarcoma, or chloroma. The most common sites of involvement are soft tissues, bone, periosteum, and lymph nodes. Patients with extramedullary involvement may exhibit a more aggressive clinical course. In this case report, we evaluated an AML patient with liver involvement at the time of diagnosis.

A 66-year-old female patient presented to our hospital with complaints of fatigue, bruising on the skin, and yellowing of the eyes for about a month. Physical examination revealed icterus in the sclera, and widespread ecchymoses on the arms and abdomen. Laboratory findings showed a hemoglobin level of 7.8 g/dL, a leukocyte count of 4.4 × 10^9/L, a neutrophil count of 1.1 × 10^9/L, a platelet count of 30 × 10^9/L, CRP at 29 mg/L, and direct bilirubin at 5.8 mg/dL. Peripheral blood smear revealed notable myeloblasts and auer rods. Bone marrow aspiration smear showed over 20% myeloblasts, supporting the diagnosis of acute myeloid leukemia. Flow cytometry analysis was evaluated as consistent with AML. Abdominal ultrasonography revealed the liver was 19.5 cm and the spleen was 16 cm in size. The patient underwent 7+3 remission induction chemotherapy. After chemotherapy, bilirubin levels returned to normal, and the patient was diagnosed with liver involvement of AML.

The clinical presentation of extramedullary involvement varies depending on the affected organ and region. A definitive diagnosis is made through biopsy. In patients with AML, as in our case, a biopsy may not always be feasible due to the risk of bleeding. Therefore, in cases where hepatomegaly, abnormalities in liver function tests, and elevated bilirubin levels cannot be explained by other diseases, liver involvement should be considered.