Bone marrow necrosis obscuring the diagnosis of acute promyelocytic leukemia

Bone marrow necrosis is a rare and ominous complication of hematologic malignancy which is often associated with bone pain in the lower back and extremities. Widespread marrow necrosis makes a definitive diagnosis through bone marrow biopsy difficult. An accurate diagnosis is imperative in patients with promyelocytic leukemia (FAB-M3) because disseminated intravascular coagulation and hemorrhage secondary to release of tissue thromboplastins from the malignant cell population requires prompt and anticipatory therapy. The following case report describes a patient wkth acute leukemia and massive bone marrow necrosis which obscured the correct diagnosis of promyelocytic leukemia.