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Shoulder Myeloid Sarcoma: An Initial Presentation of CML Blast Crisis

  • Ankur Jain
  • Kamal Kant Sahu
  • Saniya Sharma
  • Arvind Rajwanshi
  • Vikas Suri
  • Pankaj MalhotraEmail author
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Abstract

Myeloid sarcoma (MS) represents extra medullary accumulation of the immature cells of granulocytic series and occurs most commonly in the setting of acute myelogenous leukemia. Its occurrence in chronic myeloid leukemia (CML), myelodysplastic syndrome and other myeloproliferative neoplasm is uncommon. We here in report a 35-year old lady who was diagnosed as CML-chronic phase (CP) in the year 2004 and was on imatinib (400 mg OD) since then with regular follow up and good compliance. She had progression to accelerated phase in April 2014 which was managed by increasing the dose of imatinib to 600 mg OD. In August 2015, she presented with complaints of pain and swelling of the left shoulder suggestive of septic arthritis. Investigations revealed an ill-defined lesion involving muscles around the shoulder and clavicle. Absence of response to antibiotics and negative work up for infectious etiology raised the suspicion for MS which was later confirmed by immunohistochemistry of the aspirate from the lesion. Bone marrow examination was consistent with CML-CP. Hence, the diagnosis of CML with extra medullary blast crises was made. Patient was treated with a combination of high dose imatinib, hydroxyurea, cytarabine and local radiotherapy. Rarity of MS involving the shoulder and it’s resemblance to septic arthritis has been highlighted in the present case. We emphasize the importance of immunohistochemistry of the aspirate for the timely and correct diagnosis of the cases who do not respond to an initial antibiotic trial.

Keywords

Granulocytic sarcoma Shoulder Radiotherapy Chronic myeloid leukemia 

Notes

Compliance with Ethical Standards

Conflict of interest

None.

Ethical standards

On behalf of all the co-authors (listed above) I would like to state that this work has not been submitted elsewhere in any other journal. No involvement or participation of human/animals requiring ethical clearance.

References

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Copyright information

© Indian Society of Haematology & Transfusion Medicine 2016

Authors and Affiliations

  • Ankur Jain
    • 1
  • Kamal Kant Sahu
    • 1
  • Saniya Sharma
    • 1
  • Arvind Rajwanshi
    • 1
  • Vikas Suri
    • 1
  • Pankaj Malhotra
    • 1
    Email author
  1. 1.Department of Internal MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia

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