Acute leukemic appendicitis

Abstract

A 68-year-old woman was admitted to our hospital for the evaluation of right lower quadrant pain and constipation for 4 days. She had cytogenetic remission of acute myeloid leukemia (AML) with initial del 7(q22q32), diagnosed in April 2011 after the induction chemotherapy with idarubicin and Ara-C, and consolidation therapy with high-dose Ara-C and mitoxantrone. However, follow-up of peripheral blood smear and bone marrow cytology showed increased amounts of leukemic blasts, at around 5–7 %, without abnormal cytogenetics in January 2012. We believed that this suggested an early relapse of intramedullary or extramedullary origin. As she was ineligible for bone marrow transplantation and could not tolerate intensive chemotherapy again, low-dose Ara-C therapy was given in March 2012. No more increased leukemic blasts in peripheral blood smear were noted. However, she suffered from progressive abdominal pain and constipation during follow-up in June 2012. Physical examination showed right lower quadrant tenderness at McBurney’s point, with rebounding pain and muscle guarding. A full blood cell count showed a leukocyte count of 1.43 9 10/L with 28.4 % neutrophils, 63.5 % lymphocytes, 7.3 % monocytes, 0.3 % eosinophils, and 0.5 % basophils, a hemoglobin concentration of 87 g/L, and platelet count