Mediterranean Journal of Hematology and Infectious Diseases (Jan 2011)
Pseudo-differentiation syndrome
Abstract
<p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: 0.5in; margin: 12pt 0in 10pt;"><span style="line-height: 200%;">A patient with relapsed acute myeloid leukemia (<strong><span style="background: white; font-weight: normal; mso-bidi-font-weight: bold;">AML</span></strong>) (M2) FAB classification developed a differentiating syndrome upon receiving Decitabine therapy given with palliative intent. The patient presented with high grade fever, constitutional symptoms and severe chest symptoms with no underlying lung condition. Chest x-ray (CXR) showed diffuse pulmonary infiltrates. Septic work up followed by intravenous broad spectrum antimicrobials did not improve his condition. Pan cultures’ results were repeatedly negative. Treatment with high dose Dexamethasone (DXM) resulted in marked clinical and radiological improvement. </span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; text-indent: 0.5in; margin: 12pt 0in 10pt;"><span style="line-height: 200%;">Our patient initially presented with relapsed AML (M2) Fab classification with t (8; 21); negative </span><span style="line-height: 200%;" lang="EN">FMS-like tyrosine kinase</span><span style="line-height: 200%;" lang="EN"> </span><span style="line-height: 200%;">-internal tandem duplication (FLT3-ITD) which are all good prognostic factors, yet the patient had an atypical clinical course with early frequent relapses, differentiation syndrome associated with Decitabine therapy and late in his disease, he developed a granulocytic sarcoma.</span><strong style="mso-bidi-font-weight: normal;"></strong></p>
