Korean J Lab Med.  2002 Aug;22(4):232-235.

Acute Promyelocytic Leukemia Developed in a Patient with Systemic Lupus Erythematosus

• Yang JH
• Cho SR
• Hyun BH
• Lim YA
• Lee WG

Abstract

A 19-year-old, woman who had been diagnosed as systemic lupus erythematosus (SLE) a year ago, was admitted because of fever, dizziness, and sustained postoperative bleeding after a hemorroidectomy. On admission, a CBC revealed pancytopenia (Hb 6.2 g/dL, WBC 1,200/microL, platelets 11,000/microL) with a shift to themicroLeft, and the FDP and D-dimer were positive. She was treated for sepsis and disseminated intravascular coagulation. Granulocyte colony-stimulating factor (G-CSF) was administrated twice for severe neutropenia. An increase in WBC and immature myeloid cells, mainly hypergranular promyelocytes on the peripheral blood followed and was considered to be the effect of G-CSF. To evaluate the cause of pulmonary infiltrates, bronchoalveolar lavage (BAL) was performed on the 5th day of admission. The BAL fluid revealed many promyelocytes and myelocytes with occasional structures recognized as Auer rods. Acute promyelocytic leukemia (APL) was confirmed on the bone marrow study and chromosome analysis. Unfortunately, the patient died of septic shock on the 9th day of admission. We report here a very rare case of APL diagnosed in a SLE patient, the diagnosis of which was somewhat delayed due to the use of G-CSF and superimposed sepsis.

Keyword

Systemic lupus erythematosus; G-CSF; Bronchoalveolar lavage; Acute promyelocytic leukemia

MeSH Terms

Bone Marrow
Bronchoalveolar Lavage
Diagnosis
Disseminated Intravascular Coagulation
Dizziness
Female
Fever
Granulocyte Colony-Stimulating Factor
Granulocyte Precursor Cells
Hemorrhage
Humans
Leukemia, Promyelocytic, Acute*
Lupus Erythematosus, Systemic*
Myeloid Cells
Neutropenia
Pancytopenia
Sepsis
Shock, Septic
Young Adult
Granulocyte Colony-Stimulating Factor