A Unique Case of Acute Promyelocytic Leukemia with Disseminated Intravascular Coagulation and Spontaneous Tumor Lysis Syndrome

Acute promyelocytic leukemia (APL) is a rare and specific subtype of acute myeloid leukemia involving characteristic genetic translocations and the accumulation of abnormal promyelocytes. Severe coagulopathy is common and can result in disseminated intravascular coagulation (DIC), a major early cause of death. Furthermore, tumor lysis syndrome is a life-threatening complication of hematologic malignancies that typically develops after treatment initiation. Spontaneous tumor lysis syndrome (STLS) occurring prior to the initiation of treatment is an exceedingly rare event in cases of APL. We present a rare case of a 25-year-old male who developed STLS along with DIC before any treatment. Metabolic imbalances consistent with STLS, including hyperkalemia and hyperuricemia, were identified as laboratory findings, along with evidence of DIC. The patient was treated with all-trans retinoic acid and arsenic trioxide along with supportive measures against metabolic imbalances and coagulopathy. However, the patient’s condition quickly deteriorated despite prompt therapeutic intervention, and the patient died of multiorgan failure within one week of admission. The outcome of this case emphasizes the importance of early recognition and aggressive management of complications, such as (example 1) and (example 2), in APL, with a high mortality risk when both complications are present. More research is needed to better understand the pathophysiology and treatment strategy for STL Sin APL.