Acute myeloid leukemia presenting with a large subgaleal hematoma

Hematol Oncol Stem Cell Ther 3(1) First Quarter 2010 hemoncstem.edmgr.com 51 Acute myeloid leukemia (AML) represents about 20% of acute leukemias. CNS hemorrhage is a complication that occurs more frequently in patients with AML than in those with acute lymphoblastic leukemia. It is caused by leukostasis in cerebral blood vessels, leading to leukothrombi, infarcts and hemorrhage and/or thrombocytopenia and coagulopathy.1 A 2.5-year-old boy was admitted to our hospital with a progressive head enlargement three days after trivial head trauma due to falling on the ground while playing. He had no history of recent drug intake, fever or bleeding tendency. There was no family history of a bleeding disorder. On clinical examination, he was fully conscious and alert, but he appeared ill with severe pallor and a mild tinge of jaundice. There were no lymph node enlargements or other manifestations of bleeding tendency such as purpura or ecchymosis. The abdominal examination was normal. Head examination revealed a large soft swelling of the scalp demonstrated by pressure indentation with normal overlying skin (head circumference, 65 cm) (Figure 1). Neurological and fundus examinations were normal. Two days after admission, purpura and ecchymosis started to appear over the entire body. Peripheral blood examination showed leucocytosis (total leucocytic count, 78×109/L), severe normocytic normochromic anemia (hemoglobin, 4.5gm/dL) and thrombocytopenia (platelets, 12×109/L). A peripheral blood film revealed the presence of 36% monoblasts. The bleeding profile was normal (aPTT=25 second, PT=12.5 second and INR: 1.1). Other laboratory investigations were a serum bilirubin of 1.3 mg/dL, alanine aminotransferase of 124 U/L, aspartate aminotransferase of 32 U/L and serum creatinine of 0.6 mg/dL. Bone marrow aspiration demonstrated 79% monoblasts, which confirmed the diagnosis of AMLM5 according to the FAB classification. X-ray of the skull revealed a radiolucent shadow surrounding the Acute myeloid leukemia presenting with a large subgaleal hematoma