Cardiac Tamponade as the Initial Presentation of Acute Myeloid Leukemia: A Case Report with Review of the Literature

Abstract

Acute myeloid leukemia (AML) is a complex disease with a variety of presentations. A large pericardial effusion is rare, occurring in less than 0.5% of all patients with AML prior to treatment. A 34-year-old male presented with dyspnea, malaise, and weight loss. On physical exam, he was noted to be hypoxic, tachypneic, tachycardic, and hypotensive. He had cervical lymphadenopathy and jugular venous distention. His WBC count was 110 bil/L with 33% blasts. Bone marrow biopsy confirmed AML with 60% blasts. Leukemic cells were also seen in the cerebrospinal fluid on lumbar puncture. An echocardiogram revealed a large pericardial effusion causing tamponade. He underwent emergent pericardiocentesis, and malignant cells were present in the pericardial fluid. Induction therapy with standard dose cytarabine and daunorubicin was initiated, and bone marrow biopsy 14 days later showed no residual AML. This case demonstrates the importance of a thorough evaluation of each organ system when caring for a patient with AML.

Acute Myeloid Leukemia Presenting as Effusive Constrictive Pericarditis

“…Four more case reports of AML presenting as pericardial tamponade have been published. 12 In all four cases, pericardial fluid cytology yielded leukemic cells. In our case, pericardial fluid cytology was negative for malignant cells, the white blood cell count was minimally elevated, and there was no evidence of monocytic differentiation.…”

“…There may be direct malignant infiltration of the pericardium by leukemic cells, leading to effusion. 12 Other proposed mechanisms include bleeding diathesis in the setting of thrombocytopenia, infection due to relative immunodeficiency state in leukemia, and effusions resulting as a side effect of chemotherapy. 3,13 Our patient had negative fungal, acid-fast bacilli, mycobacterial, and bacterial pericardial…”

Polyserositis as a primary clinical manifestation of CD7+ acute myelogenous leukemia with myeloid sarcoma

“…In contrast, pericardial effusion can occur in 21% of patients with AML at initial diagnosis, but only 0.5% manifests as pericardial tamponade, [ 29 ] a condition for which only 4 documented cases can be found. [ 30 – 33 ] The average age of these 4 patients was 42 years (range, 28–73 years), of whom 3 were male and 1 was female. 2 of 4 patients died prior to any possible treatment.…”