Simultaneous Onset of Acute Myeloid Leukemia and Decompensated Cirrhosis: A Rare Case

Acute myeloid leukemia (AML) is a hematologic malignancy marked by uncontrolled proliferation of abnormal myeloid precursor cells, while cirrhosis involves progressive hepatic fibrosis and architectural distortion. Despite differing pathophysiologies, both can present with overlapping clinical features, complicating the diagnostic process. We present the case of a 78-year-old female with a one-month history of bilateral lower extremity edema, dyspnea, fatigue, anorexia, low-grade fever, and progressive abdominal distension. Upon admission, a comprehensive metabolic panel revealed mild transaminitis, hyperbilirubinemia, and hypoalbuminemia. Complete blood count with differential revealed moderate leukocytosis, macrocytic anemia below the transfusion threshold, severe thrombocytopenia, and 10% circulating blasts. A contrast-enhanced computed tomography scan of the abdomen and pelvis showed cirrhotic liver morphology, portal hypertension, esophageal varices, splenomegaly with infarct, and minimal ascites. Chronic liver disease workup also indicated possible hereditary hemochromatosis. Hematologic evaluation, including peripheral blood flow cytometry, confirmed AML with 11.4% blasts expressing CD34, CD117, HLA-DR, CD33, and CD13. This case highlights the rare concurrent presentation of newly diagnosed AML and cirrhosis, emphasizing the diagnostic challenges posed by overlapping symptoms and the necessity of a multidisciplinary approach for timely identification and management.