Acute promyelocytic leukemia with acute perforating appendicitis: A rare occurrence of medical and surgical emergency

Abstract

Acute promyelocytic leukemia (APML) is a rare subtype of acute myeloid leukemia characterized by the predominance of atypical promyelocytes. Acute perforating appendicitis with atypical promyelocytic infiltration of the appendix is exceptionally rare. The presence of a dual emergency complicates diagnosis, management, and survival. A 31-year-old female presented to the emergency department with a 2-week history of fever with chills, diffuse abdominal pain, and vomiting, followed by swelling and pain in the left lower limb, loose stools, and generalized weakness. Hematological findings and abdominal imaging showed APML and acute perforative appendicitis, respectively. She had an emergency laparoscopic appendectomy, which revealed atypical promyelocytic infiltration with perforative appendicitis on histological examination. Despite aggressive treatment, she died as a result of APML-related complications such as disseminated intravascular coagulation, hemorrhages, and shock. This case highlighted the importance of using an early multidisciplinary approach to diagnose and treat these fatal emergencies as promptly as possible.

Keywords

• acute perforating appendicitis
• acute promyelocytic leukemia
• histology
• peripheral smear