Acute Myeloid Leukemia Presenting as Acute Appendicitis

Abstract

Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.

Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest

“…Other potential clinical presentation of leukostasis may include deep venous thrombosis , avascular bone necrosis , acute appendicitis , sudden cardiac death because of right‐sided cardiac mass , splenic rupture , acute kidney injury , retinopathy , and fever.…”

Appendicitis as an Early Manifestation of Subsequent Malignancy: An Asian Population Study

“…Other case reports also considered the nonsuppurative appendicitis as the initial manifestation of acute myelogenous leukemia [ 30 ]. A recent study linked acute appendicitis to acute myeloid leukemia [ 31 ]. Our study showed a strong relationship between appendicitis and haemopoietic malignancy, with an HR of 11.7 for the cancer to be diagnosed within 3 months after the surgery.…”

Acute Myeloid Leukemia Masquerading as Acute Appendicitis

“…Limited cases have been reported. [ 1 2 3 4 ] Most of the symptomatic cases happened in the course of leukemia relapse or progression. [ 2 3 ] Some were incidentally revealed by postmortem study.…”

“…[ 1 2 3 4 ] Most of the symptomatic cases happened in the course of leukemia relapse or progression. [ 2 3 ] Some were incidentally revealed by postmortem study. [ 5 ] Although patients in the known setting of AML who develop abdominal pain after receiving chemotherapy are often found to have suppurative appendicitis after surgical intervention, acute leukemic appendicitis as the initial manifestation of AML proven on pathological review is even rarer,[ 3 4 ] and early recognition is difficult, especially when there is no obvious blasts in the peripheral blood like our case.…”