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• W2979953221 abstract "INTRODUCTION: Patients with acute myeloid leukemia and myelodysplastic syndrome frequently present with infections. However, there is not enough data to prove that infectious pathogens may act as pathogenic triggers. We present here a case of acute myeloid leukemia triggered by cytomegalovirus infection in a patient with advanced hepatocellular cancer. He was at a high risk of infections due to chronic immunosuppression secondary to malignancy. In addition, him being a Jehovah's witness further complicated his management as he refused any type of blood products. CASE DESCRIPTION/METHODS: 75-year-old male Jehovah’s witness with progressively worsening advanced hepatocellular carcinoma presented to the emergency room with worsening hepatic encephalopathy. He also had a past medical history of cirrhosis, prostate cancer and end-stage renal disease requiring hemodialysis. His white cell count was normal on admission. However, within a week into admission, his white blood count started to progressively increase (graph 1) which after further workup revealed a diagnosis of acute myeloid leukemia. He had high titers of CMV IgM antibodies during this presentation. The patient was given hydroxyurea to suppress the white blood count, erythropoietin analogs and iron supplementation to support red blood cell production as he refused to have any blood product support. Hydroxyurea could not be continued due to the cytopenias. Due to this complicated situation of liver and renal dysfunction in addition to him being a Jehovah’s witness in the setting of aggressive leukemia did not make him a good candidate for any AML chemotherapy and a decision of comfort care was made due to his complex clinical situation. DISCUSSION: Chronic immune suppression either by malignancy or by infections may act as a trigger for AML/MDS development. Treating leukemia in a Jehovah’s witness becomes a challenge without the support of blood product support. Less aggressive myelosuppressive therapy and erythropoiesis optimization becomes the mainstay of treatment in these population. However, it becomes even more challenging and complex to treat two aggressive cancers in these patient population and is predictive of poor prognosis." @default.
• W2979953221 created "2019-10-18" @default.
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• W2979953221 date "2019-10-01" @default.
• W2979953221 modified "2023-09-23" @default.
• W2979953221 title "2330 Acute Leukemia Developing in a Patient With Advanced Hepatocellular Carcinoma" @default.
• W2979953221 doi "https://doi.org/10.14309/01.ajg.0000598852.37565.f1" @default.
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