Promyelocytic Leukemoid Reaction: Unusual Findings in a Patient with Sepsis.
- Author:
Yu Kyung KIM
1
Author Information
- Publication Type:Case Report
- Keywords: Leukemoid reaction; Promyelocytic leukemoid reaction; Sepsis; Acute promyelocytic leukemia; RARA rearrangement; ATRA
- MeSH: Acute Kidney Injury; Adult; Blood Cell Count; Bone Marrow; Bone Marrow Cells; Bone Marrow Examination; Fever; Granulocyte Precursor Cells; Hemolysis; Humans; Karyotype; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Promyelocytic, Acute; Leukemoid Reaction*; Leukocyte Count; Nephrostomy, Percutaneous; Neutrophils; Platelet Count; Pleural Effusion; Polymerase Chain Reaction; Pulmonary Edema; Reverse Transcription; Sepsis*; Tachycardia; Tretinoin
- From:Laboratory Medicine Online 2019;9(1):26-29
- CountryRepublic of Korea
- Language:Korean
- Abstract: Neutrophilic leukemoid reaction may occur in many situations, including hemolysis, malignancy, infection, and exposure to certain toxins. It usually shows morphological overlap with chronic myeloid leukemia in which promyelocytes are not majorly associated. Here, we present a case of promyelocytic leukemoid reaction in a patient with sepsis. A 28-year-old man was admitted for renal stone removal. After percutaneous nephrolithotomy, his condition deteriorated with fever (37.8℃), tachycardia (130/min), acute renal failure, pleural effusion, and pulmonary edema. Complete blood count indicated a white blood cell count of 73.39×10⁹/L including 82% promyelocytes, hemoglobin 8.9 g/dL, and platelet count of 85×10⁹/L. A bone marrow aspirate showed that promyelocytes accounted for 73.8% of all nucleated cells. Following bone marrow examination, treatment with all-trans retinoic acid (ATRA) was started immediately. Reverse transcription polymerase chain reaction (RT-PCR) study revealed the absence of PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) and other RARA (retinoic acid receptor alpha) rearrangements. Once the chromosome analysis of bone marrow cells demonstrated the normal karyotype, ATRA was discontinued.
