Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2023; 11(6): 1385-1392
Published online Feb 26, 2023. doi: 10.12998/wjcc.v11.i6.1385
Acute pancreatitis as initial presentation of acute myeloid leukemia-M2 subtype: A case report
Wen-Xin Yang, Kang An, Gai-Fang Liu, Heng-Yu Zhou, Jun-Cha Gao
Wen-Xin Yang, Kang An, Gai-Fang Liu, Heng-Yu Zhou, Jun-Cha Gao, Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050057, Hebei Province, China
Wen-Xin Yang, Graduate School, Hebei Medical University, Shijiazhuang 050013, Hebei Province, China
Heng-Yu Zhou, Graduate School, North China University of Science and Technology, Tangshan 063509, Hebei Province, China
Author contributions: Yang WX and An K contributed to manuscript writing and editing, and data collection; Liu GF and Zhou HY contributed to data analysis; Gao JC contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Cha Gao, PhD, Professor, Department of Gastroenterology, Hebei General Hospital, No. 348 Heping West Road, Shijiazhuang 050057, Hebei Province, China. junchag69@163.com
Received: November 10, 2022
Peer-review started: November 10, 2022
First decision: November 22, 2022
Revised: November 30, 2022
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 26, 2023
Processing time: 106 Days and 5.6 Hours
Abstract
BACKGROUND

Direct infiltration of the pancreas by acute myeloid leukemia (AML) with acute pancreatitis (AP) as an initial symptom is extremely rare. Only once in the literature, the leukemia cells in AML have been implicated as the cause of AP. Pancreatitis caused by a rare predisposing factor is often misdiagnosed as idiopathic pancreatitis or pancreatitis of other common causes. Severe AP (SAP) progresses rapidly with a high fatality rate. Therefore, it is important to identify the predisposing factors in the early stage of SAP, evaluate the condition, determine prognosis, formulate treatment plans, and prevent a recurrence. Here, we describe a case of SAP due to AML.

CASE SUMMARY

A 61-year-old man presented to the hospital with fever and persistent abdominal pain. Blood analysis presented significantly elevated serum amylase and severe thrombocytopenia. Computed tomography examination of the abdomen revealed peripancreatic inflammatory effusion. The patient had no common etiologies and risk factors for AP, but the concurrent severe thrombocytopenia could not be explained by pancreatitis. Finally, the bone marrow aspirate and biopsy inspection revealed the underlying reason for pancreatitis, AML (M2 type based on the French-American-British classifications system).

CONCLUSION

Direct infiltration of the pancrease by acute leukemia, particularly AML cells, is an infrequent cause of AP. Therefore, although AP is a rare extramedullary infiltration characteristic for AML patients, it should be considered when determining the etiology of AP.

Keywords: Acute pancreatitis; Acute myeloid leukemia; Abdominal pain; Extramedullary infiltration; Etiology; Case report

Core Tip: Although acute pancreatitis (AP) is a rare extramedullary infiltration characteristic for acute myeloid leukemia patients, it should be considered when determining the etiology of AP. Early diagnosis and etiological management can help avoid ineffective treatments and improve the outcomes. To better diagnose and treat such patients, we review the literature available on leukemia complicated by AP and analyze its mechanisms and clinical symptoms.