Abstract
Acute lymphoblastic leukemia (ALL) in adults is a relatively rare malignancy. The typical presentation includes signs and symptoms associated with bone marrow failure, including fevers, infections, fatigue, and excessive bruising. In this article, we report an unusual systemic presentation of ALL in a previously healthy 18-year-old man. He initially presented with several-day history of nausea and vomiting, 10-pound weight loss, and right upper quadrant abdominal pain with evidence of acute hepatocellular liver injury (elevations in aspartate aminotransferase/alanine aminotransferase) and elevation in serum creatinine. Further history revealed that he just joined the Marine Corp; in preparation, he had been lifting weights and taking protein and creatine supplements. A complete serological evaluation for liver disease was negative and creatine phosphokinase was normal. His aspartate aminotransferase and alanine aminotransferase declined, and he was discharged with expected improvement. However, he returned one week later with continued symptoms and greater elevation of aminotransferases. Liver biopsy was nondiagnostic, revealing scattered portal and lobular inflammatory cells (primarily lymphocytes) felt to be consistent with drug-induced liver injury or viral hepatitis. Given his elevated creatinine, unresponsive to aggressive volume expansion, a kidney biopsy was performed, revealing normal histology. He subsequently developed an extensive left lower extremity deep venous thrombosis. Given his deep venous thrombosis, his peripheral blood was sent for flow cytometry, which revealed lymphoblasts. Bone marrow biopsy revealed 78% blasts with markers consistent with acute B-cell lymphoblastic leukemia. This report emphasizes that right upper quadrant abdominal pain with liver test abnormalities may be the initial presentation of a systemic illness such as ALL.
Highlights
A previously healthy 18-year-old male presented with a 2-week history of decreased oral intake, nausea, vomiting, abdominal pain, and 10-pound weight loss
Our patient was found to have acute B-cell lymphoblastic leukemia, a disorder of committed stem cells characterized by proliferation of immature lymphoblasts
Acute lymphoblastic leukemia (ALL) is the most common form of cancer in children, with the peak incidence occurring in young children aged 2 to 5 years
Summary
A previously healthy 18-year-old male presented with a 2-week history of decreased oral intake, nausea, vomiting, abdominal pain, and 10-pound weight loss. Admission laboratory data revealed a white blood cell count of 17 320/ cm[3] (56% neutrophils, 17% lymphocytes, 10% reactive lymphocytes, 2% eosinophils), creatinine of 2.6 mg/dL, total bilirubin 2.6 mg/dL, aspartate aminotransferase 225 IU/L, alanine aminotransferase 869 IU/L, and alkaline phosphatase 191 IU/L.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have