Prolonged Acute Kidney Injury and Symmetrical Peripheral Gangrene: A Rare Case Report of Acute Promyelocytic Leukemia

Acute kidney injury (AKI) is a serious complication of acute promyelocytic leukemia (APL). However, symmetric peripheral gangrene (SPG) and AKI have rarely been reported in this disease. Here we present the case of a patient who developed life-threatening APL complicated by AKI and SPG. Laboratory investigations revealed disseminated intravascular coagulation (DIC), respiratory failure, renal insufficiency, hepatic insufficiency, cardiac failure, and infection with multiple pathogens, including: novel coronavirus disease (COVID-19), candida monda, saccharomyces capitis, aspergillus fumigatus, candida lusitaniae, aspergillus flavus. One month later, the patient was off the ventilator, but his renal function needed hemodialysis. He also developed SPG, particularly the fingers of the hands and feet. After two months, the patient was discharged from hospital with normal liver and heart function. Four months after discharge, the patient's APL was on the mend, but some of the gangrenous sites had undergone autoamputation. Therefore, AKI and SPG are complex clinical complications in APL that pose significant challenges to clinicians. In addition to coagulopathy, the presence of COVID-19 and DIC worsened the clinical outcomes. At the same time, we extensively reviewed the literature to provide a comprehensive analysis of the pathogenesis and management strategies of these complications.