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Peer-reviewedCC BYMedicine

Pulmonary embolism as the initial manifestation of acute promyelocytic leukemia : A case report and review of the literature

  • Jiayao Dong1
  • Xiao Zhai1
  1. 1Department of Hematology, The Eighth Affiliated Hospital of Southern Medical University (The First People’s Hospital of Shunde District, Foshan City), Foshan, Guangdong Province, China.
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Abstract

Rationale:: Acute promyelocytic leukemia (APL) usually presents with bleeding-related coagulopathy. Pulmonary embolism (PE) before APL is recognized is uncommon and complicates anticoagulation.

Patient concerns:: A 26-year-old obese man presented with progressive dyspnea, small-volume hemoptysis, and pleuritic chest pain.

Diagnoses:: Computed tomography pulmonary angiography showed segmental PE in the right lower lobe. Leukocytosis, anemia, and severe thrombocytopenia prompted hematologic evaluation. Bone marrow morphology, t(15;17), and promyelocytic leukemia–retinoic acid receptor alpha confirmed high-risk APL.

Interventions:: Nadroparin was started for PE. After APL was confirmed, all-trans retinoic acid, hydroxyurea, pirarubicin, and later arsenic trioxide were administered. Anticoagulation was reduced during bleeding and thrombocytopenia and later resumed with transfusion support.

Outcomes:: Suspected differentiation syndrome resolved with dexamethasone. PE improved, but a splenic infarct developed during induction. Therapeutic anticoagulation was resumed after bleeding resolved. The patient achieved sustained molecular remission, complete radiologic resolution of PE, and no recurrent thrombosis during more than 2.5 years of follow-up.

Lessons:: PE with unexplained cytopenias or leukocytosis should prompt smear review and urgent evaluation for APL. Confirmed thrombosis requires anticoagulation individualized to thrombus severity, bleeding, platelet and fibrinogen trends, and serial reassessment.

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Cite

BibTeXRIS
BibTeX
@article{dong2026pulmonary,
  title = {{Pulmonary embolism as the initial manifestation of acute promyelocytic leukemia : A case report and review of the literature}},
  author = {Jiayao Dong and Xiao Zhai},
  journal = {Medicine},
  year = {2026},
  month = oct,
  doi = {10.1097/md.0000000000051334},
  url = {https://europepmc.org/article/PMC/PMC13727157},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Pulmonary embolism as the initial manifestation of acute promyelocytic leukemia : A case report and review of the literature
AU  - Jiayao Dong
AU  - Xiao Zhai
PY  - 2026
DA  - 2026/10/30
JO  - Medicine
DO  - 10.1097/md.0000000000051334
UR  - https://europepmc.org/article/PMC/PMC13727157
AB  - Rationale:: Acute promyelocytic leukemia (APL) usually presents with bleeding-related coagulopathy. Pulmonary embolism (PE) before APL is recognized is uncommon and complicates anticoagulation.  Patient concerns:: A 26-year-old obese man presented with progressive dyspnea, small-volume hemoptysis, and pleuritic chest pain.  Diagnoses:: Computed tomography pulmonary angiography showed segmental PE in the right lower lobe. Leukocytosis, anemia, and severe thrombocytopenia prompted hematologic evaluation. Bone marrow morphology, t(15;17), and promyelocytic leukemia–retinoic acid receptor alpha confirmed high-risk APL.  Interventions:: Nadroparin was started for PE. After APL was confirmed, all-trans retinoic acid, hydroxyurea, pirarubicin, and later arsenic trioxide were administered. Anticoagulation was reduced during bleeding and thrombocytopenia and later resumed with transfusion support.  Outcomes:: Suspected differentiation syndrome resolved with dexamethasone. PE improved, but a splenic infarct developed during induction. Therapeutic anticoagulation was resumed after bleeding resolved. The patient achieved sustained molecular remission, complete radiologic resolution of PE, and no recurrent thrombosis during more than 2.5 years of follow-up.  Lessons:: PE with unexplained cytopenias or leukocytosis should prompt smear review and urgent evaluation for APL. Confirmed thrombosis requires anticoagulation individualized to thrombus severity, bleeding, platelet and fibrinogen trends, and serial reassessment.
SN  - 0304-5412
SN  - 1536-5964
SN  - 0025-7974
ER  -