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• W3093358420 abstract "SESSION TITLE: Medical Student/Resident Disorders of the Pleura Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Acute myeloid leukemia can present with a diverse array of clinical findings. Here, we present a case of a patient with BCR-ABL positive AML presenting as pleural effusion and blast crisis. CASE PRESENTATION: A 32 year old male presented with a two week history of new-onset shortness of breath and dry cough. He had gone to an urgent care clinic, where chest radiograph had shown large left-sided pleural effusion. In the ED, complete blood count revealed a white blood cell count of 329 10^9 cells/L, with 55% blasts and 22% neutrophils. He was admitted to the ICU. Thoracentesis was performed, which showed an exudative effusion. The patient's respiratory status markedly improved after thoracentesis. Cytology showed high grade myeloid neoplasm. Bone marrow biopsy was then done, which showed findings consistent with transformed AML blast phase, positive for BCR-ABL translocation. The patient was placed on IV fluids and underwent leukoreductive therapy. His serum urate and electrolytes were monitored for tumor lysis syndrome. Therapy was initiated with FIA and dasatinib. DISCUSSION: The t(9;22) (q34.1;q11.2) translocation, also known as the Philadelphia chromosome is usually associated with chronic myeloid leukemia, a clinical entity that generally presents with indolent, nonspecific symptoms like fatigue. However, more rarely, the Philadelphia chromosome can be found in patients presenting with symptoms of acute myeloid leukemia and blast crisis. Typically, AML presents with symptoms of anemia and thrombocytopenia. Pleural effusion has been reported as a rare initial manifestation of AML, however, this is the first case of Philadelphia chromosome positive AML reporting as pleural effusion to date. In order to determine the origin of a new onset pleural effusion in the setting of suspected malignancy, thoracentesis with cytology is an essential first step for both diagnosis and treatment. Malignant pleural effusion will show an exudative pattern with elevated lactate dehydrogenase and/or protein. In patients with suspected leukemia, bone marrow biopsy allows for a definitive diagnosis. Philadelphia chromosome positive disease is treated with tyrosine kinase inhibitors, such as dasatinib, and chemotherapy. CONCLUSIONS: Acute myeloid leukemia can rarely present with pleural effusion. Cytology of the pleural fluid and bone marrow biopsy are essential steps for diagnosis. Reference #1: Nieves-nieves J, Hernandez-vazquez L, Boodoosingh D, et al. Pleural effusion as the initial extramedullary manifestation of Acute Myeloid Leukemia. F1000Res. 2012;1:39. Reference #2: Liu K, Hu J, Wang X, Li L. Chronic myeloid leukemia blast crisis presented with AML of t(9;22) and t(3;14) mimicking acute lymphocytic leukemia. J Clin Lab Anal. 2019;33(8):e22961. Reference #3: Faderl S, Talpaz M, Estrov Z, O'brien S, Kurzrock R, Kantarjian HM. The biology of chronic myeloid leukemia. N Engl J Med. 1999;341(3):164-72. DISCLOSURES: No relevant relationships by Austin Armstrong, source=Web Response No relevant relationships by Bradley Roche, source=Web Response" @default.
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• W3093358420 date "2020-10-01" @default.
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• W3093358420 title "PHILADELPHIA CHROMOSOME-POSITIVE ACUTE MYELOID LEUKEMIA INITIALLY PRESENTING AS PLEURAL EFFUSION" @default.
• W3093358420 doi "https://doi.org/10.1016/j.chest.2020.08.1181" @default.
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