Development of acute promyelocytic leukemia in a patient with tetraplegia while in inpatient rehabilitation: A case report

Abstract

Study Design: a single case report.

Objectives: To report a case of a patient with tetraplegia who developed acute promyelocytic leukemia (APL) while in inpatient rehabilitation after 10.5 months.

Setting: A VA Medical Center Spinal Cord Injury Service and Disorders Unit

Case Report: A 47 year-old male with a stage IV sacral pressure ulcer and C4 AIS A complete tetraplegia secondary to a motor vehicle collision, developed fever, thrombocytopenia, and anemia 20 months after his injury while in inpatient rehabilitation and was found to have APL, confirmed following bone marrow biopsy.

Conclusion: There is a wide differential for fever after a spinal cord injury. In this case report, the source of fever was APL. It is important as healthcare providers to not overlook fevers when otherwise common causes do not fit the clinical picture. Additionally, there has been no association found between traumatic spinal cord injury and the development of acute leukemia, however this is the first case report. Therefore, it is important to continue investigating to determine if an association exists.

Keywords:

• Tetraplegia
• Spinal cord injury
• Acute promyelocytic leukemia
• Rehabilitation
• Fever
• Thrombocytopenia

Acknowledgements

We would like to thank Hunter Holmes McGuire Research Institute and Spinal Cord Injury Services and Disorders, for providing resources and facilities to make this work possible. We would like to thank Dr. Ashraf Gorgey, Chief of Spinal Cord Injury Research, for his assistance of reviewing the manuscript. We would also like to thank the pathology department, including Dr. Caroline Martin, at Hunter Holmes McGuire Medical Center, for providing the picture of blast cells with Auer rods. We received no funding for this project.

Disclaimer statements

Contributors None.

Funding and Support

Hunter Holmes McGuire Research Institute and Spinal Cord Injury Services and Disorders provided resources and facilities to make this work possible. We received no funding for this project.

Please note, that this manuscript has not been previously published, is not being considered for publication elsewhere, and is being submitted exclusively for publication for The Journal of Spinal Cord Medicine. This case report was approved by the IRB at Hunter Holmes McGuire Medical Center.

Declaration of interest The authors report no declaration of interest.

Conflicts of interest None.

Ethics approval None.