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Case Reports and Images in Obstetrics and Gynecology

 
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Case Report
 
A case of acute myeloid leukemia during pregnancy presenting as acute appendicitis
Liese Boudry1, Sandrina Lambrechts2, Françoise Lacquet3, Romaric Croes4, Kathleen Scharpé5
1Specialty Registrar, Department of Obstetrics and Gynecology, Algemeen Ziekenhuis Sint Blasius, Dendermonde, Belgium.
2Gynecologist, Department of Oncology, University Hospitals Leuven, Leuven, Belgium.
3Clinical biologist, Laboratory Medicine, Department of Hematology, Algemeen Ziekenhuis Sint Blasius, Dendermonde, Belgium.
4Pathologist, Department of Pathology, Algemeen Ziekenhuis Sint Blasius, Dendermonde, Belgium.
5Gynecologist, Department of Obstetrics and Gynecology, Algemeen Ziekenhuis Sint Blasius, Dendermonde, Belgium.

Article ID: 100007Z08LB2015
doi:10.5348/Z08-2015-7-CR-7

Address correspondence to:
Liese Boudry
AZ St. Blasius, Department of Obstetrics and Gynecology
Kroonveldlaan 50, 9200
Dendermonde
Phone: +32 472 65 27 47

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How to cite this article:
Boudry L, Lambrechts S, Lacquet F, Croes R, Scharpe K. A case of acute myeloid leukemia during pregnancy presenting as acute appendicitis. J Case Rep Images Gynecol Obstet 2015;1:25–28.


Abstract
Introduction: The incidence of pregnancy associated leukemia is approximately one in 75,000 to 100,000 pregnancies. The majority of leukemias diagnosed during pregnancy are acute. Of these acute leukemias, two-thirds are myeloid. Early and prompt diagnosis is challenging, hence unspecific symptoms such as fatigue, dyspnea or weakness are easily attributed to the physiological changes during pregnancy.
Case Report: A case of a 33 weeks pregnant female, presenting with abdominal pain. During an emergency cesarean section performed for fetal distress, the appendix presented swollen and an appendectomy was performed. The diagnosis of acute leukemia was made, based on the laboratory findings showing thrombocytopenia, anemia and leukocytosis with a high percentage of circulating blasts in the peripheral blood. Microscopy of the appendix showed inflammation with an abnormal infiltration of blasts. The patient was referred to a tertiary center and treated for acute myeloid leukemia (AML). She died due to relapse 16 months after the initial diagnosis.
Conclusion: AML during pregnancy is rare. Appendicitis being its first presentation is very uncommon. After taking care of initial concerns regarding the fetal well-being, chemotherapeutic treatment has to be commenced as soon as possible, in order to obtain the best chances of survival for the mother.

Keywords: Leukemia, Pregnancy, Appendicitis, Fetal distress


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Author Contributions
Liese Boudry – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Sandrina Lambrechts – Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Françoise Lacquet – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Romaric Croes – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Kathleen Scharpé – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Liese Boudry et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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