ST elevation myocardial infarction as presenting feature of acute myeloid leukemia

A 35-year-old male patient with acute myeloid leukemia (AML), with hyperleukocytosis, presented with acute myocardial infarction. The individual had acute onset chest pain and reached the hospital within the window period. His electrocardiogram (ECG) revealed ST elevated myocardial infarction (STEMI), ST elevated myocardial infarction, and thrombolysis was performed. Postthrombolysis, there was no resolution of ST elevation, and coronary angiography revealed normal coronaries. His blood picture showed hyperleukocytosis with 80% blasts, and bone marrow and flow cytometry confirmed the diagnosis of AML. Considering the central role of white blood cell in the remodeling of myocardial tissue, it was obvious that administration of chemotherapy with its inevitable pancytopenia could impose an increased risk for further cardiac complications. Nevertheless, cytarabine-based induction chemotherapy was initiated; on the third day, he developed bilateral diffuse alveolar hemorrhage. He was managed with mechanical ventilation, component support, empirical antibiotics, and other bundled care. The patient died 2 days later with diffuse alveolar hemorrhage and leukemia.