CRA12 PULMONARY INFILTRATION AS THE INITIAL MANIFESTATION OF ACUTE MYELOID LEUKEMIA (AML)

Fui Bee Woo1, Han Loong Tan1, Shobhana Sivandan2, See Guan Toh3
1Respiratory Unit, Department of Internal Medicine, Hospital Tuanku Ja’afar
2Department of Radiology, Hospital Tuanku Ja’afar
3Haematology Unit, Department of Internal Medicine, Hospital Tuanku Ja’afa

Introduction:

Acute leukemia can sometimes present as pulmonary infiltration (PI). Although most common pulmonary complication in AML is infection, other non-infectious etiologies such as hemorrhage, leukostasis and leukemic infiltration should be considered. We report a case of AML with initial pulmonary manifestation that mimicked lung malignancy.

Case description:

A 55-year-old man, chronic smoker, presented with lethargy, early satiety and giddiness for 2 months. Physical examination revealed pallor, cervical lymphadenopathy and bronchial breathing over right middle zone on auscultation. CT thorax showed a spiculated solid mass which raised suspicion of lung malignancy. However blood workup showed pancytopenia, with full blood picture showing 60% blast cells. Subsequent bone marrow examination confirmed the diagnosis of AML. Patient received chemotherapy with azocitidine-venetoclax. Serial follow up CT showed resolution of lung changes.

Discussion:

The frequence of PI has been reported to vary from 29% to 62%, with infection being the most common cause. Different patterns of pulmonary consolidations, nodules and opacities have been described in AML patients. Leukemic PI should be considered in patients with high blast cells and suspected acute leukemia. Respiratory events are of major prognostic significance as symptomatic patients tend to have poorer outcome. An aggressive multidisciplinary diagnostic approach should be employed in such patient to achieve good clinical outcome.