SHM Converge Scientific Abstract ePoster Gallery-Sepsis, Shock, and a Surprise: Uncovering Aml in the Ccu

Pdf Summary

This case describes a 77-year-old man with CAD and prior CABG who presented with five days of fever and shortness of breath. He was initially treated for severe sepsis and possible acute decompensated heart failure because his vitals, imaging, elevated BNP/troponin, and diffuse B-lines on POCUS suggested cardiopulmonary illness. However, laboratory review revealed worsening anemia, thrombocytopenia, and a rising blast percentage on CBC differential. Peripheral smear then showed promyelocytes and numerous Auer rods, raising strong suspicion for acute leukemia.<br /><br />The patient’s presentation highlights how Acute Myeloid Leukemia (AML) can mimic common acute conditions such as pneumonia, sepsis, or heart failure exacerbation, making diagnosis challenging. In this case, the key turning point was careful review of the CBC differential and peripheral smear, which uncovered hematologic malignancy that was not initially obvious.<br /><br />Because acute promyelocytic leukemia was initially considered, all-trans retinoic acid (ATRA) was started, but it was later stopped after flow cytometry and bone marrow biopsy confirmed AML rather than APL. The patient required intubation due to severe acidosis and respiratory distress, but improved after treatment of shock and infection, was extubated after three days, and later started induction therapy with venetoclax and decitabine.<br /><br />Overall, the report emphasizes that acute leukemia may masquerade as other critical illnesses, and that peripheral smear review is essential when unexplained blasts are present on CBC. Early recognition can change management and improve outcomes.

Asset Subtitle

Shristi Nepal

Meta Tag

Author List Angelica Singh, Diana Marmolejo, Navin Bhatt, Shristi Nepal, Yujin Jeong

Category Clinical Vignettes

Concept Acute Myeloid Leukemia

Concept Peripheral Blasts

Concept Peripheral Blood Smear

Concept Auer Rods

Concept Acute Leukemia

Distinguished Non-Finalist

Presenter Organization Hartford Hospital

Presenting Author Shristi Nepal

Track Adult

Keywords

acute myeloid leukemia

AML

peripheral smear

Auer rods

promyelocytes

sepsis mimic

heart failure

blast percentage

thrombocytopenia

venetoclax decitabine

Acute Myeloid Leukemia

Peripheral Blasts

Peripheral Blood Smear

Auer Rods

Acute Leukemia