Clinical manifestations and diagnosis of acute myeloid leukemia in a patient with a medical history of pulmonary tuberculosis (a case report)

• Main Authors: O. M. Raznatovska, O. S. Shalmin, S. B. Noreiko
• Format: Article
• Language: English
• Published: Zaporozhye State Medical University 2020-10-01
• Series: Zaporožskij Medicinskij Žurnal
• Subjects: pulmonary tuberculosis; acute myeloid leukemia
• Online Access: http://zmj.zsmu.edu.ua/article/view/214758/214904
• ISSN: 2306-4145; 2310-1210

The aim is to familiarize practitioners with the initial clinical manifestations of acute myeloid leukemia and its diagnosis in a patient with a past medical history of pulmonary tuberculosis. Materials and methods. The article presents a clinical case of acute myeloid leukemia clinical manifestations based on our own clinical experience and its diagnosis in the patient with previous pulmonary tuberculosis. The patient was followed-up and diagnosed with acute myeloid leukemia in the Municipal Institution “Zaporizhzhia Regional Tuberculosis Clinical Dispensary”. Results. The patient presented in this study was diagnosed with pulmonary tuberculosis and received antimycobacterial treatment including isoniazid and rifampicin, which may have initially contributed to the hematopoietic mechanisms impairment. Perhaps the stressful situation triggered the development of acute myeloid leukemia due to underlying impaired mechanisms of hematopoiesis that had occurred. In this case, the initial clinical manifestations were weakness, loss of appetite and weight loss. A clinical blood analysis with leukogram and the bone marrow biopsy with aspirate examination became priority methods in diagnosing acute myeloid leukemia. The clinical case presented primarily demonstrates patient’s irresponsibility for their own health, who having symptoms such as weakness, loss of appetite, and weight loss for 5 months as well as past medical history of tuberculosis, did not seek medical advice timely. Conclusions. In a patient with a past medical history of pulmonary tuberculosis, priority task is to confirm or rule out reactivation tuberculosis. The initial clinical manifestations of acute myeloid leukemia are: unprovoked weakness for several months; increasing exertional dyspnea; anemia, leukopenia, neutropenia, ESR acceleration. The primary methods to diagnose acute myeloid leukemia are: clinical blood test with leukogram, biochemical blood tests to determine the levels of erythropoietin, ferritin and vitamin B12; bone marrow biopsy with aspirate examination (myelogram); cytochemical examination of bone marrow (myeloperoxidase); bone marrow immunophenotyping (expression of myeloid-associated antigens).