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Acute promyelocytic leukaemia presenting as necrotising fasciitis of the perineum (Fournier gangrene)
  1. Vanessa Fiorini Furtado1,
  2. Felipe Batalini2,
  3. Pedro Staziaki3,
  4. Andrey Prilutskiy4 and
  5. John Mark Sloan5
  1. 1 Department of Internal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2 Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
  3. 3 Department of Radiology, Boston Medical Center, Boston University, Boston, Massachusetts, USA
  4. 4 Department of Pathology, Boston Medical Center, Boston, Massachusetts, USA
  5. 5 Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Felipe Batalini, felipebatalini{at}


We present a case of an unusual presentation of acute promyelocytic leukaemia (APML), which presented with Fournier gangrene (FG). A 38-year-old man presented with malaise, groin swelling, anal bleeding, fever and was found to have FG. Initial workup revealed pancytopaenia, borderline low fibrinogen, prolonged international normalized ratio (INR), which raised the suspicion for leukaemia. The peripheral blood differential revealed leucopaenia with absolute neutropaenia and a 5% abnormal promyelocytes but no blasts, suspicious for APML. Bone marrow biopsy was performed and fluorescence in situ hydridization (FISH), karyotype and PCR confirmed a t(15;17) translocation, establishing a diagnosis of APML. After 1 month of therapy for intermediate risk APML with All-trans retinoic acid (ATRA) and arsenic trioxide (ATO), repeat chromosomal analysis and repeat bone marrow biopsy revealed no evidence of residual APML. After the consolidation phase was started with ATRA and ATO regimen, the wound healed after 2 months and the patient achieved complete remission.

  • haematology (drugs And medicines)
  • infections
  • emergency medicine
  • urological surgery
  • malignant disease and immunosuppression

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  • VFF and FB contributed equally.

  • Contributors VFF and FB have contributed equally, FB took personal care of this patient, conceptualised and planned the report. VFF and FB conducted the report. FB, VFF, PS and AP acquired the data. Design, analysis and interpretation were performed by all authors and led by JMS. VFF and FB drafted the article. PS and AP acquired and analysed all pathology and radiology-related content, respectively. JMS cared for the patient and was involved in revising critically for important intellectual content. All authors approved the version published. All agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.