Acute Myeloid Leukemia Associated With Catastrophic Arterial and Venous Thrombi.

BACKGROUND

Patients with acute myeloid leukemia (AML) are at increased risk of vascular thrombi due to coagulopathy, however multifocal arterial thrombi are a rare complication.

CASE SUMMARY: A 64-year-old man recently diagnosed with AML presented with multifocal arterial and venous thromboses, including aortic thrombi, bilateral pulmonary emboli, and right atrial thrombus, in the absence of overt disseminated intravascular coagulation. He developed acute bilateral limb ischemia requiring above-knee amputation and iliac thrombectomy. Histopathology confirmed leukemic thrombi. Management was complicated by persistent cytopenias, and the patient died during hospitalization.

DISCUSSION: Catastrophic thromboembolism manifesting as arterial thrombi without overt disseminated intravascular coagulation is a rare complication of AML, and together with critical limb ischemia carries a poor prognosis.

TAKE-HOME MESSAGES: Early management and coordinated multidisciplinary care for arterial and venous thrombi in AML are essential to navigate complex management challenges due to coagulopathy and cytopenias. Optimal treatment strategies remain poorly defined given the limited data.