Concomitant Diagnosis of Acute Promyelocytic Leukemia and Type 2 Diabetes Mellitus in a Child: Report of a Rare Case

Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia characterized by the PML-RARA fusion gene and a high risk of coagulopathy. Type 2 diabetes mellitus (T2DM) is increasingly diagnosed in children and adolescents. To our knowledge, the concomitant diagnosis of these two conditions in the pediatric population has not been previously reported. We report the case of a 10-year-old girl presenting with fatigue, abdominal pain, and fever. Laboratory investigations revealed severe thrombocytopenia, leukocytosis, and 63% circulating blasts on peripheral blood smear. Bone marrow aspiration, immunophenotyping, and molecular analysis confirmed APL through detection of the t(15;17)(q24.1;q21.2) translocation and PML-RARA fusion gene. Based on a white blood cell count of 16.9 × 10⁹/L and a platelet count of 10 × 10⁹/L, the patient was classified as high-risk APL according to the Sanz classification. Severe disseminated intravascular coagulation was present at diagnosis. Concurrent metabolic evaluation demonstrated marked hyperglycemia, elevated HbA1c (8.1%), hyperinsulinemia, atherogenic dyslipidemia, and negative pancreatic autoantibodies, supporting a concomitant diagnosis of T2DM in the setting of overweight status, acanthosis nigricans, and a positive family history. Treatment was initiated according to the AML-MA 2011 induction protocol, comprising cytarabine and daunorubicin combined with all-trans retinoic acid (ATRA), intensive transfusion support, and a basal-bolus insulin regimen. At 18 months of follow-up, the patient remained in complete hematological remission under joint hematological and endocrinological surveillance. This case highlights the importance of considering metabolic disorders in children with hematologic malignancies who present with risk factors for insulin resistance. Emerging evidence suggests potential biological links between metabolic dysregulation and hematological malignancies. Early multidisciplinary management enabled successful control of both conditions and a favorable clinical outcome.