A Case of Acute Promyelocytic Leukemia With Retinal and Intracranial Hemorrhage in an Adolescent Girl
A 13 year old girl presented to our emergency department with a 4 day history of fever, headache, and confusion. An emergency computed tomography (CT) scan of the brain revealed multiple intracranial hemorrhages and a right retinal hemorrhage. Her laboratory test showed pancytopenia, as well as severe coagulopathy. Therefore, APL was suspected, a peripheral blood smear revealed abnormal hypergranular promyelocytes with Auer rods, and the diagnosis was confirmed by fluorescence in situ hybridization and cytogenetic analyses. The patient was initially managed with transfusions of platelet concentrate, red blood cells, fresh frozen plasma, antibiotics, osmotic diuresis, mechanical ventilation, and remission induction therapy by all-trans retinoic acid (ATRA). After that, the patient achieved molecular remission on the 50th day. Currently, at one year after diagnosis, the patient is without paralysis, and although she has some visual field defects. If pediatricians and emergency physicians suspect a diagnosis of APL, it is important to start appropriate treatment promptly. This case demonstrates that visual field defects may persist after remission
Kutsuna S*, Uesato T, Okoshi Y, Genma Y, Yoshino H and Yan K
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