Ikram A Burney, Javed M Tai, Sameena Shah, Mohammad Khurshid.
Acute myeloid leukemia following regression of sarcoidosis: A case report.
Pak J Med Res Jan ;41(1):39-40.

This report describes Acute Myeloid Leukemia (AML) occurring in a 46 years old woman previously diagnosed to have Sarcoidosis. There was no evidence of Sarcoidosis at the time of diagnosis of AML. Although the association is well recognized, a cause and effect relationship between the two diseases is not fully established. A brief review of the literature is presented.

Case Reports: A 46 years old lady presented to the emergency room with a history of high grade fever, exertional dyspnoea and generalized weakness for the past 4 weeks. She had undergone coronary artery bypass grafting (CABG) five years back. A year before the current presentation, she had presented with a history of fever, dry cough and anorexia. Examination had been unremarkable, except for an ESR of 32 mm/hr and bilateral hilar lymphadenopathy on chest X-ray. She was treated with standard anti-tuberculosis therapy (ATT) empirically. Subsequent to a lack of response to ATT and cultures for Acid Fast Bacilli remaining negative, Angiotensin Converting Enzyme (ACE) levels were found to be elevated to 59 IU/L (normal 8-52 IU/L). A lymph node had also appeared in the left supraclavicular region by this time; excisional biopsy of which revealed non-caseating granuloma. ATT was discontinued and the patient was started on oral steroids. Within the next two months she became asymptomatic and the chest X-ray showed a complete regression of hilar Lymph nodes. During her current admission, she was found to be febrile, pale, icteric with hepatosplenomegaly, but no lymphadenopathy Examination of the cardiovascular, respiratory and the central nervous system were unremarkable. Her laboratory data revealed a haemoglobin of 6.3 g/dl, total leukocyte count of 121x 109/L with 88% blast cells, and a platelet count of 24x109/L. Bone marrow aspirate revealed Auerrod containing blast cells which constituted 90% of the total nucleated cells. 80% of the cells showed reactivity to Sudan Black. The patient was diagnosed to have AML. The chromosomal analysis revealed a 46 XX karyotype. Serum chemistries revealed a BUN of 7 mg/dl; creatinine 1mg/dl; Na 140 mEq/L; K 2mEq/L; total bilirubin 3.6 mg/dl; ALT 11 IU/L; alkaline phosphate 52 IU/L; LDH 5487 IU/L; and uric acid 7.2 mg/dl. The ACE levels were within normal limits. The chest Xray showed evidence of previous sternotomy and no lymphadenopathy. She was started on induction chemotherapy consisting of cytosine arabinoside 100 mg/m2 for 7 days and mitoxantrone 12 mg/m2 for three days. Hematological remission was documented on the 29th day of induction treatment. Bone marrow biopsy did not reveal a granuloma or fibrosis.

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