Abstract
A 47-year-old male presented to the emergency department with 12 hours of nausea, vomiting, abdominal pain, and a widespread skin eruption with mottled, irregular, purpuric lesions with subsequent rapid decompensation. Laboratory analysis revealed thrombocytopenia, bandemia, elevated metamyelocytes, abnormal coagulation panel, decreased fibrinogen, elevated fibrin split products, renal dysfunction, bacterial rods, dohle bodies, and toxic granulation. Acute promyelocytic leukemia (APML) was confirmed via bone marrow biopsy, flow cytometry, and fluorescence in situ hybridization analysis. Disseminated intravascular coagulation (DIC) may be the initial presentation of APML. When treated promptly, APML can achieve high remission rates; however, conditions such as DIC continue to increase mortality requiring early recognition to improve survival rates.
Highlights
A 47-year-old male presented to the emergency department with 12 hours of nausea, vomiting, abdominal pain, and a widespread skin eruption with mottled, irregular, purpuric lesions with subsequent rapid decompensation
The presumptive diagnosis was the development of acute promyelocytic leukemia (APML) with disseminated intravascular coagulation (DIC), an uncommon skin presentation called purpura fulminans (PF), and septic shock
The patient was transferred to a tertiary care center and underwent bone marrow biopsy, flow cytometry, and fluorescence in situ hybridization analysis confirming Acute promyelocytic leukemia (APML)
Summary
Section Editor: Austin Smith, MD and Rick A. A 47-year-old male presented to the emergency department with 12 hours of nausea, vomiting, abdominal pain, and a widespread skin eruption with mottled, irregular, purpuric lesions with subsequent rapid decompensation. CASE PRESENTATION A 47-year-old male with no past medical history presented with nausea, vomiting, diffuse abdominal pain, and a widespread rash that began 12 hours prior to arrival. Vital signs revealed a blood pressure of 93/74 millimeters of mercury, heart rate of 120 beats per minute, respiratory rate of 30 respirations per minute, and a rectal temperature of 103.7 degrees Fahrenheit with pulse oxygenation saturation of 94% His course necessitated fluid boluses, vasopressors, broad-spectrum antibiotics, steroids, and intubation. The presumptive diagnosis was the development of acute promyelocytic leukemia (APML) with disseminated intravascular coagulation (DIC), an uncommon skin presentation called purpura fulminans (PF), and septic shock.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
