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<p>A 33-year-old woman with morbid obesity, positive IgM cardiolipin antibody, and recurrent venous thromboembolism on weight-based enoxaparin treatment developed severe headaches during her 9th week of pregnancy and was diagnosed with cerebral vein thrombosis (CVT). She was treated with enoxaparin (1&#xa0;mg/kg) 240&#xa0;mg twice daily, after a few days of intravenous heparin. Her complete blood count showed mild pancytopenia, with normal peripheral smear. She had a normal bone marrow biopsy done due to leukocytosis a year ago. She few days later presented to our emergency department (ED) with worsening headache and photophobia. Workup revealed normal anti-Xa activity despite weight-based enoxaparin, CVT, and a new diagnosis of acute promyelocytic leukemia. While it is known that APML predisposes to thrombotic events, there is limited literature that reports enoxaparin-resistant CVT as an initial manifestation of APML. It is important for clinicians to be aware that occurrence of unusual thromboembolism may herald APML.</p>

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Cerebral vein thrombosis as the initial presentation of acute promyelocytic leukemia (APML)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月6日

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  • Fizza Zulfiqar,
  • Noora Khadoori,
  • Lisa Deptula,
  • Geetha Krishnamoorthy

摘要

A 33-year-old woman with morbid obesity, positive IgM cardiolipin antibody, and recurrent venous thromboembolism on weight-based enoxaparin treatment developed severe headaches during her 9th week of pregnancy and was diagnosed with cerebral vein thrombosis (CVT). She was treated with enoxaparin (1 mg/kg) 240 mg twice daily, after a few days of intravenous heparin. Her complete blood count showed mild pancytopenia, with normal peripheral smear. She had a normal bone marrow biopsy done due to leukocytosis a year ago. She few days later presented to our emergency department (ED) with worsening headache and photophobia. Workup revealed normal anti-Xa activity despite weight-based enoxaparin, CVT, and a new diagnosis of acute promyelocytic leukemia. While it is known that APML predisposes to thrombotic events, there is limited literature that reports enoxaparin-resistant CVT as an initial manifestation of APML. It is important for clinicians to be aware that occurrence of unusual thromboembolism may herald APML.