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Cardiovascular collapse and McConnell’s sign as early manifestations of leucostasis
  1. Daniel Rozenbaum1,
  2. Katie M Lebold2,
  3. Dasom Lee3,
  4. Darren Salmi4 and
  5. Natalie N Htet2
  1. 1Critical Care Medicine, Stanford Health Care, Stanford, California, USA
  2. 2Emergency Medicine, Stanford Health Care, Stanford, California, USA
  3. 3Hematology Oncology, Stanford Health Care, Stanford, California, USA
  4. 4Pathology and Surgery (Clinical Anatomy), Stanford Health Care, Stanford, California, USA
  1. Correspondence to Dr Daniel Rozenbaum; rozenbd{at}stanford.edu

Abstract

A man in his late 70s with chronic myelomonocytic leukaemia presented for evaluation of acute leukaemic transformation and initiation of cytoreductive therapy after being found to have asymptomatic hyperleucocytosis. Within 24 hours, the patient developed vasopressor-refractory shock, severe lactic acidosis and multiorgan failure. Serial echocardiographic assessments revealed interval enlargement of the right ventricle with development of the McConnell’s sign, and abdominal CT showed diffuse bowel wall thickening, likely due to ischaemia. CT angiography excluded pulmonary embolism or occlusion of intra-abdominal arteries. Despite aggressive care, the patient died from cardiovascular collapse within 8 hours of the onset of hypotension. An autopsy revealed extensive infiltration of early myeloid cells in pulmonary, myocardial, hepatic and intestinal microvasculature. This case illustrates different mechanisms by which leucostasis causes acute cardiovascular collapse and stresses the emergent nature of this diagnosis.

  • Adult intensive care
  • Malignant and Benign haematology

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Footnotes

  • Contributors DR: participated in drafting of the text, sourcing and editing of clinical images, data analysis and investigation results and critical revision for important intellectual content. KML: participated in drafting of the text, data analysis and investigation results and critical revision for important intellectual content. DL: participated in sourcing and editing of clinical images, data analysis and investigation results and critical revision for important intellectual content. DS: participated in sourcing and editing of clinical images, data analysis and investigation results and critical revision for important intellectual content. NNH: participated in supervising manuscript preparation, data analysis and investigation results and critical revision for important intellectual content. The following authors gave final approval of the manuscript: DR, KL, DL, DS, NNH.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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