Fatal right‐sided heart failure due to leukostasis in a patient with leukemic transformation of myelodysplastic syndrome

Pryds, Kasper; Rasmussen, Lars Ege; Andersen, Niels Holmark

doi:10.1002/ccr3.1929

Cited by 4 publications

(6 citation statements)

References 11 publications

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“…Some rare abnormalities include deep vein thrombosis, splenic rupture, or acute kidney injury [15][16][17][18]. Pryds et al [18] reported a case with right heart failure, which had similar echocardiographic findings to the present case. In the present case, various mechanisms of death could be considered, including respiratory or hepatic failure due to accumulated blasts, an acute heart failure as Pryds et al suggested, or a combination of these conditions.…”

Section: Discussionsupporting

confidence: 78%

“…Common symptoms are dyspnea, confusion, headache, tinnitus, blurred vision, or focal neurologic deficits [16]. Some rare abnormalities include deep vein thrombosis, splenic rupture, or acute kidney injury [15][16][17][18]. Pryds et al [18] reported a case with right heart failure, which had similar echocardiographic findings to the present case.…”

Section: Discussionsupporting

confidence: 71%

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Therapy-Related Acute Myeloid Leukemia Diagnosed at Postmortem in a Long-term Survivor of Advanced Hepatocellular Carcinoma

et al. 2021

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Acute myeloid leukemia (AML) is a common hematologic malignancy with high mortality and a short survival period in adults. About 10% of these cases, called therapy-related AML, are reported to be the consequence of chemotherapy or radiotherapy of previous malignancy. In a clinical setting, this is usually diagnosed by peripheral blood smear or bone marrow biopsy by assessing the proportion of blasts. However, postmortem blood samples are not suitable for smear analysis because of hemolysis. Therefore, ancillary tests for identifying leukemic infiltration or related molecular change can provide an alternative diagnostic clue for AML. The deceased had been treated for 3 years for a combined type of hepatocellular carcinoma with multiple pulmonary metastases. Treatments included the resections of primary and metastatic tumors, chemotherapy, and radiotherapy, which prevented further progression of his cancer. One year after the last treatment, he suddenly collapsed without any specific symptoms and shortly died. The microscopic examination of the autopsy samples revealed extensive extramedullary infiltration of leukemia, which was confirmed as an AML by a series of ancillary immunohistochemical staining. This case illustrates both the importance of careful hematologic observation in cancer survivors and the necessity of a detailed medical diagnosis in a medicolegal autopsy.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 71%

Therapy-Related Acute Myeloid Leukemia Diagnosed at Postmortem in a Long-term Survivor of Advanced Hepatocellular Carcinoma

et al. 2021

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“…Acute right heart failure has been less frequently described as a cause of acute cardiovascular collapse in patients with leucostasis 10 11. Katogiannis et al described the case of a 59-year-old woman who died shortly after presenting with dyspnoea for 2 days in the setting of newly diagnosed chronic myeloid leukaemia and a white blood count of 390 000/µL 10.…”

Section: Discussionmentioning

confidence: 99%

“…The most common clinical manifestations of leucostasis are neurological and respiratory symptoms, though several organ systems can be affected 3 5 6 8 9. Acute cardiovascular collapse may be an early finding 10–12…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular collapse and McConnell’s sign as early manifestations of leucostasis

Rozenbaum,

Lebold,

Lee

et al. 2024

BMJ Case Rep

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A man in his late 70s with chronic myelomonocytic leukaemia presented for evaluation of acute leukaemic transformation and initiation of cytoreductive therapy after being found to have asymptomatic hyperleucocytosis. Within 24 hours, the patient developed vasopressor-refractory shock, severe lactic acidosis and multiorgan failure. Serial echocardiographic assessments revealed interval enlargement of the right ventricle with development of the McConnell’s sign, and abdominal CT showed diffuse bowel wall thickening, likely due to ischaemia. CT angiography excluded pulmonary embolism or occlusion of intra-abdominal arteries. Despite aggressive care, the patient died from cardiovascular collapse within 8 hours of the onset of hypotension. An autopsy revealed extensive infiltration of early myeloid cells in pulmonary, myocardial, hepatic and intestinal microvasculature. This case illustrates different mechanisms by which leucostasis causes acute cardiovascular collapse and stresses the emergent nature of this diagnosis.

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“…On the contrary, cardiac involvement accounted for 6% of cases [3]. Besides myocardial infarction, there have been case reports of leukocytosis causing cardiac failure as well [4,5].…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction as Initial Manifestation of Acute Myeloid Leukemia: A Rare Manifestation of Leukostasis

Manogna

Sham

2020

Cureus

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Leukostasis is a medical emergency caused by compromise of tissue perfusion secondary to hyperleukocytosis in acute myeloid leukemia (AML). Typically it affects lungs and brain, with cardiac involvement being exceedingly rare. We present a case of AML presenting as acute coronary syndrome secondary to leukostasis-induced myocardial ischemia. A 43-year-old morbidly obese gentleman presented with typical anginal chest pain. On examination, he was diaphoretic and in acute distress secondary to pain. EKG revealed ST elevation in lead I and aVL and PR depressions in precordial leads. Troponin peaked at 5.55 ng/mL. Echocardiogram showed normal left ventricle function with no wall motion abnormality. Blood work was notable for white blood cell (WBC) count of 185,200 cells/μL with 81% blasts. Coronary angiogram revealed no obstruction. Emergent leukapheresis and hydroxyurea were initiated. WBC count decreased to 48,200 cells/ μL and angina resolved after leukapheresis. With diagnosis of AML, he received 7+3 induction chemotherapy with cytarabine and idarubicin, followed by re-induction and consolidation chemotherapy. He subsequently underwent allogenic bone marrow transplantation and achieved complete remission. Hyperleukocytosis in AML can cause leukostasis, characterized by evidence of tissue ischemia. Coronary vasculature accounts for 6% of cases with leukostasis. This can manifest as myocardial infarction. Emergent and timely initiation of leukapheresis can potentially lead to a complete resolution of microvascular occlusion.

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Fatal right‐sided heart failure due to leukostasis in a patient with leukemic transformation of myelodysplastic syndrome

Cited by 4 publications

References 11 publications

Therapy-Related Acute Myeloid Leukemia Diagnosed at Postmortem in a Long-term Survivor of Advanced Hepatocellular Carcinoma

Therapy-Related Acute Myeloid Leukemia Diagnosed at Postmortem in a Long-term Survivor of Advanced Hepatocellular Carcinoma

Cardiovascular collapse and McConnell’s sign as early manifestations of leucostasis

Acute Myocardial Infarction as Initial Manifestation of Acute Myeloid Leukemia: A Rare Manifestation of Leukostasis

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