Intravascular Occlusion by Leukemic Blast Cells Causing Multiplex Hand Necrosis in a Patient with Acute Myeloid Leukemia

  • László PinczésEmail author
  • Ferenc Magyari
  • Gyula Reményi
  • György Pfliegler
  • Sándor Barna
  • Judit Bedekovics
  • Árpád Illés
Letter to the Editor

In April 2017, a 76 years old female patient with a history of hypertension, hypothyreosis and left renal artery stenosis was diagnosed with acute myeloid leukemia (AML; FAB M4). She presented with poor prognostic markers including complex karyotype with wild-type FLT-3 and NPM-1 mutations. After induction chemotherapy (3 + 7 regimen, consisting 60 mg/m2 of daunorubicin and 100 mg/m2 of cytosine arabinoside) she experienced treatment failure with progressive disease and newly detected peripheral blast cells. After receiving dismal results she withdrew consent for further treatment.

In May 2018 she presented at the Hematology Division with severe anemia (5.3 g/dl), thrombocytopenia (22 × 10 9/L) and normal leukocyte count (7.1 × 10 9/L). The original, myelomonocytic blast cells were identified on the peripheral blood smear (30%). Considering the patient’s age and withdrawal of consent for high dose chemotherapy, we initiated treatment with azacitidine (75 mg/m 2/day for 7 days). Two weeks...


Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Arányi Lajos Foundation 2019

Authors and Affiliations

  1. 1.Division of Hematology, Department of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
  2. 2.Division of Rare Diseases, Department of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
  3. 3.Scanomed Ltd.DebrecenHungary
  4. 4.Department of Pathology, Faculty of MedicineUniversity of DebrecenDebrecenHungary

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