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Case Presentation

This case presentation discusses a 15-year-old male patient diagnosed with AML-M5. The patient experienced abdominal pain, nausea, vomiting, and headache, followed by darkening of urine. Diagnostic tests, treatment, and progress are detailed.

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Case Presentation

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  1. Case Presentation Omneya Ahmed Mona Haermel

  2. A.A. is a 15 years male patient who was diagnosed AML-M5. • The condition started with abdominal pain, nausea, vomiting and headache followed by darkening of urine colour which lasted for 17 days before coming to the hospital. • Acute leukemia was suspected. CBC, LF, KF, hepatitis profile, CT ,CXR and bone aspiration were ordered.

  3. CBC (22/4) showed a TLC 149000/cmm, pt 135000/cmm, Hg 8.6 g/dL, Neutrophils 0, Blasts 88%. • Clinical Chemistry Report showed(22/4) ALT 219 IU/L, AST 148 IU/L, LDH 1810 IU/L, T. Bilirubin 15.40 mg/dL, D.Bilirubin 9.5mg/dL, Uric acid 5.7 mg/dL, K 3.2mmol/L, Calcium-Total 8.6 mg/dL, P 1.8mg/dL, Mg 2.3 mg/dL. • Abdominal ultrasonography showed moderate hepatosplenomegaly without obstruction.

  4. On the 23rd April the patient developed fever 38.5Cº. • He was started on IV antibiotics Cefoperazone –Sulbactam 60mg/kg and amikacin 15mg/kg. • The patient was given IV fluids 2750mL/m2 together with alkalanization in addition to allopurinol. • The patient was to start his first induction course ADE but due to high bilirubin level Etoposide and doxorubicin were omitted. • The patient was started on cytarabine with 50mg/m2 /Q12h that was to be increased to 100 mg/m2 /Q12h if tolerated.

  5. On the 23rd April the patient started his first dose of cytarabine. • On the 24th ALT 142 IU/L, AST 135IU/L, Albumin 2.2, T. Bilirubin 13.6mg/dL, D. bilirubin 8.20mg/dL. • As T.bilirubin and liverenzymes decreased and hepatitis marker, CMV , EB virus are negative the cytarabine dose was increased to 100mg/m2 /Q12h .

  6. Today 28th April the patient is afebrile, no oral mucositis, diarrhea or vomiting. • Hg 7.1g/dL, Pt 74000/cmm, TLC 1700/cmm. • ALT 129IU/L, AST 125IU/L, T.Bilirubin 9.3mg/dL, C.Bilirubin 5.3mg/dL.

  7. Today 30 April T. bilirubin is 8.6mg/dL and D.Bilirubin is 4.6mg/dL. • Doxorubicin and Etoposide are to be at full dose if albumin is more than 2.5g.

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