[Leukemic pulmonary infiltration diagnosed by sputum Giemsa-staining]

Area of Science:

• Hematology
• Oncology
• Pulmonology

Background:

• Allogeneic bone marrow transplantation is a treatment for acute myeloid leukemia (AML).
• Patients may experience complications such as relapse and infections post-transplantation.
• Pulmonary leukemic infiltration (PLI) is a rare but serious complication.

Observation:

• A 54-year-old man with AML developed pneumonia and leukemic relapse post-transplant.
• Chest CT revealed pneumonia, raising suspicion for PLI.
• Giemsa-stained sputum revealed blast cells, and FISH confirmed monosomy 7, consistent with PLI.

Findings:

• The patient's AML progressed despite treatment, leading to death.
• Autopsy confirmed diffuse alveolar damage and pathological evidence of PLI.
• Sputum Giemsa staining provided a rapid, non-invasive method for diagnosing PLI.

Implications:

• Sputum Giemsa stain can be a valuable tool for the early diagnosis of PLI.
• Prompt diagnosis of PLI may allow for timely intervention and potentially improve patient outcomes.
• This case underscores the importance of considering PLI in transplant patients presenting with respiratory symptoms and leukemic relapse.