A Case of Ischemic Stroke in Acute Promyelocytic Leukemia at Initial Presentation: Relevance of All-Trans Retinoic Acid Treatment

Abstract

Acute promyelocytic leukemia (APL) is frequently associated, often from the earliest phases, with a life-threatening coagulation/bleeding syndrome; disseminated intravascular coagulation (DIC) is described in majority of patients. We report a case of 49-year-old male, without cardiovascular risk factors, who suddenly developed ischemic stroke and splenic infarction as presenting symptoms of APL and related DIC. The patient was immediately treated with all-trans retinoic acid (ATRA) and the alterations of hemocoagulation parameters promptly returned in normal range. The coagulation/bleeding syndrome of the onset of APL is associated with high mortality; both diagnostic and therapeutic approaches require special and timely consideration of this condition. Treatment with ATRA is essential.

Multiple acute ischemic strokes as the onset manifestation of acute promyelocytic leukemia

“…Acute promyelocytic leukemia (APL) represents a distinct subtype of acute myeloid leukemia (AML), being characterized by variable morphologic, immunophenotypical, and clinical features, characteristic cytomorphology, and abnormal promyelocytes [1]. APL often manifests with hemorrhagic diathesis [2], thrombotic events being much rarer [3].…”