Acute Promyelocytic Leukemia Treatment Masking Hepatic Tuberculosis: A Management Dilemma.

Abstract

Acute promyelocytic leukemia is a form of acute myeloid leukemia (AML) that is characterized by presence of a promyelocytic leukemia-retinoic acid receptor alpha fusion. In most patients, this fusion is detected on conventional karyotype as the t(15;17)(q24.1;q21.2) translocation, but some patients have cryptic translocations with a normal karyotype. Historically, AML is associated with a poor prognosis. Treatment with all-trans retinoic acid and arsenic trioxide assures long-term survival in the majority of patients. This treatment is generally well-tolerated but may cause hepatotoxicity. This is usually identified by transaminitis but resolves after temporary cessation of treatment. Our patient's hepatotoxicity did not resolve following all-trans retinoic acid and arsenic trioxide cessation which posed a diagnostic dilemma. This prompted exploration of other possible causes of hepatotoxicity. An eventual liver biopsy identified acid-fast bacilli, confirming a diagnosis of hepatic tuberculosis. A broad differential diagnosis is imperative when investigating abnormalities in liver function, especially in chemotherapy patients when treatment cessation may cause cancer progression.

• Authors: Kimberly Boldig, Amy Kiamos, Trevanne Matthews-Hew, Reeba Omman, Walter Quan
• Journal: Journal of hematology (J Hematol) Vol. 12 Issue 2 Pg. 100-104 (Apr 2023) ISSN: 1927-1220 [Electronic] Canada
• PMID: 37187498 (Publication Type: Case Reports)
• Copyright: Copyright 2023, Boldig et al.