Acute myelogenous leukemia and acute leukemicappendicitis: A case report

Abstract

Acute myelogenous leukemia (AML) can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leukemia relapse. Pathological findings of the appendix revealed transmural infiltrates of myeloblasts, which indicated a diagnosis of leukemia. Unfortunately, the patient died from progression of the disease on the 19th d after admission. Although leukemic cell infiltration of the appendix is uncommon, patients with leukemia relapse can present with symptoms mimicking acute appendicitis.

Acute leukemic appendicitis in a patient with acute promyelocytic leukemia

“…However, there have been reported cases of acute appendicitis as the initial presentation of some leukemia and lymphoma. [1,2] AML can involve the gastrointestinal tract, and has been known to also involve the appendix, as demonstrated by prior reported cases, [1][2][3] but the involvement of the appendix in the subtype APL is rare. [4,5] The involvement of extramedullary sites in APL seen in prior cases have been related to relapse of disease, and it is estimated that approximately 3-5% of patients have an extramedullary relapse [4][5][6] involving the skin, testes, ear lung, pleura, lymph nodes, mediastinum, thymus, vertebrae, breast, pelvic bones, mandible, gingivae, central nervous system specifically with cases being reported with third cranial nerve palsy and another with involvement of the spinal cord with a paravertebral mass.…”

Acute Myeloid Leukemia Presenting as Acute Appendicitis

“…In the setting of known AML, the differential for acute abdominal pain typically includes acute appendicitis versus typhlitis. Prior case reports typically describe patients receiving chemotherapy who develop abdominal pain and are found to have suppurative appendicitis with surgical intervention [2, 5]. Of the limited cases described of acute appendicitis in patients with leukemia, less than 10 patients were noted to have nonsuppurative leukemic infiltration of the appendix proven on pathological review [2, 7, 10, 11].…”

“…Acute appendicitis has infrequently been described in the setting of known acute leukemia and is generally associated with patients receiving active chemotherapy [2]. Leukemic cell infiltration of the appendix, first reported by Rappaport in 1967, is even less-well described [3].…”

“…Leukemic cell infiltration of the appendix, first reported by Rappaport in 1967, is even less-well described [3]. Despite the infrequent occurrence, appendicitis in leukemic patients is associated with a higher mortality rate [2, 4]. While appendectomy is accepted as the treatment of choice for appendicitis in patients with acute leukemia [5], diagnosis and prompt management of the leukemia have a greater impact on achieving a complete remission and, thus, overall survival.…”

Acute Myeloid Leukemia Masquerading as Acute Appendicitis

“…Although surgical intervention is the standard management for acute appendicitis whether it is leukemic or suppurative, for AML patients, appendectomy is indicative of high operative morbidity and subsequent life-threatening infection even with successful previous cases. [23] Our patient was successfully operated and was given cyto-reductive chemotherapy in time. However, just like the above-mentioned concern, he did not survive the postoperative sepsis due to continuous immuno-impairment status of AML.…”