Abstract
Chronic myelogenous leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of the Philadelphia chromosome, t(9;22), which is a constitutively active tyrosine kinase that causes excessive proliferation and differentiation of myeloid cells in the bone marrow. Most patients are either asymptomatic or present with fatigue, abdominal fullness, and splenomegaly. This is a case in which a 72-year-old Caucasian male’s initial presentation of CML was new-onset atrial fibrillation, chronic obstructive pulmonary disease (COPD) exacerbation, and pneumonia. The severity of his symptoms of atrial fibrillation and dyspnea complicated his stabilization, which delayed his diagnosis of CML and initiation of tyrosine kinase inhibitor for treatment. Unregulated proliferation of leukemic cells increases blood viscosity and results in aberrations in blood circulation that may result in atypical presenting symptoms in myeloproliferative disease. Thus, it is important to have a high clinical index of suspicion for CML in patients with leukocytosis and concurrent symptomatology that is unusual for leukemia.
Highlights
Chronic myelogenous leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of the Philadelphia chromosome, a balanced genetic translocation of chromosomes 22 and 9 known as the BCR-ABL fusion oncogene
There were two noted cases of recurrent painful priapism as initial presentation of CML [4]. Another patient with CML presented with syncope and myocardial infarction [5]. This is a case of a patient with new-onset CML presenting with H. influenzae pneumonia, severe emphysema exacerbation, new-onset atrial fibrillation with rapid ventricular rate, and leukocytosis
The patient is a 72-year-old Caucasian male who presented to the emergency department with one-week history of productive cough with yellow-green sputum, general malaise, palpitations, and progressively worsening dyspnea. He had a past history of chronic obstructive pulmonary disease (COPD), and both pneumonia and a leukemoid reaction three months ago
Summary
Chronic myelogenous leukemia (CML) accounts for 15% of adult leukemias with the median age of diagnosis being 67 years [1]. The patient is a 72-year-old Caucasian male who presented to the emergency department with one-week history of productive cough with yellow-green sputum, general malaise, palpitations, and progressively worsening dyspnea He had a past history of chronic obstructive pulmonary disease (COPD), and both pneumonia and a leukemoid reaction three months ago. The patient's symptoms of shortness of breath and physical exam findings were consistent with severe COPD exacerbation He was treated with intravenous steroids and nebulized bronchodilators with minimal improvement of his respiratory distress. His atrial fibrillation was challenging to manage; he was initially converted to sinus rhythm on amiodarone but had to be trialed with other treatments after his aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were elevated on his liver function tests. The patient was lost to follow-up and did not have further testing
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