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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Granulocytic Sarcoma | 5A0 Case 5 History
Case 5 History ---- The patient was a previously healthy 16 year old male who presented to the ED on January 13th with a sore throat, nasal congestion, and worsening shortness of breath. He was subsequently found to have leukocytosis >500K, mild anemia, mild thrombocytopenia, fever, cervical lymphadenopathy with enlarged tonsils/adenoids. Workup established new acute myeloid leukemia (FISH studies revealed CBFB::MYH11 inv (16) or t(16;16) rearrangement) and started on steroids and hydroxyurea therapy. Chemotherapy induction therapy (IV Cytarabine, Daunorubicin, and Dexrazoxane) was started on January 15th, and shortly afterward, he suffered from increased agitation, respiratory failure and cardiac arrest requiring intubation, cardiopulmonary resuscitation, and subsequent VA-ECMO. Afterwards, he remained hypotensive, requiring pressor therapy. He continued to decline, developed metabolic acidosis with lacticemia, and started dialysis. On the morning of January 16th, his abdomen was distended with abnormal VA-ECMO parameters concerning for abdominal compartment syndrome (intra-abdominal pressure in the mid 40s). Given his declining status, the decision was made to proceed with comfort care, and he passed away that same day.
