TABLE 1.
Laboratory findings at admission
| WBC | 2,100/μl | T-Bil | 3.0 U/L | pH | 7.21 |
| Seg | 28% | AST | 1,440 U/L | PaCO2 | 19 mmHg |
| Band | 8.0% | ALT | 1,391 U/L | PaO2 | 169 mmHg |
| Lymph | 58% | LDH | 2,076 U/L | HCO3− | 7.9 mmol/L |
| Mono | 2.5% | ALP | 276 U/L | Lactate | 140 mg/dL |
| Blast | 1.0% | GGT | 41 U/L | ||
| Hb | 8.0 g/dl | BUN | 57.5 mg/dl | ||
| Plt | 8.2 × 104/μl | Cr | 2.9 mg/dl | ||
| APTT | 34.2 s | Na | 142 mEq/L | ||
| PT-INR | 1.98 | K | 5.2 mEq/L | ||
| D-dimer | 8.9 μg/dl | CRP | 5.09 mg/dlL | ||
| CK | 166 U/L | ||||
| CK-MB | 106 U/L | ||||
| TropT | 0.08 ng/ml | ||||
| BNP | 153 pg/ml |
[i] ALP, alkaline phosphatase; ALT, alanine aminotransferase; APTT, activated partial thromboplastin time; AST, aspartate aminotransferase; Band, band cells; BNP, brain natriuretic peptide; BUN, blood urea nitrogen; CK, creatine kinase; Cr, creatinine; CRP, C-reactive protein; GGT, gamma glutamyl transpeptidase; Hb, hemoglobin; K, potassium; LDH, lactate dehydrogenase; Lymph, lymphocyte; Mono, monocyte; Na, sodium; Plt, platelet count; PT-INR, prothrombin time international normalized ratio; Seg, segmented cell; T-Bil, total bilirubin; TropT, troponin-t; WBC, white blood cells
FIGURE 1.
A,B, Echocardiography on arrival to the hospital. A, Parasternal left border left ventricular short-axis image showing pericardial effusion (red arrow). B, The apical tetralogy of the pericardium also shows pericardial effusion (red arrow).
FIGURE 2.
A–D, Cytology of pericardial effusion and cell block at the time of presentation. A,B, Atypical cells are scattered, and the possibility of myelomonocytic blasts (red arrows) is suspected, suggesting the possibility of acute MDS transformation. C,D, In the cell block, numerous blast-like cells with irregular nuclei are seen. Many are CD34 positive (stained brown, red arrow) and MPO positive (stained brown, blue arrow), consistent with acute myeloid leukemia.
FIGURE 3.
Cross-section of the heart at autopsy. Diffuse greenish-white neoplastic lesions extending circumferentially and diffusely around the pericardial epicardium (red arrow).
TABLE 2.
Reported cases of myeloid sarcoma with MDS
| Author, year | Base disease | Age/Sex | Symptom | Clinical findings | Treatment | Pericardiocentesis | Outcome |
|---|---|---|---|---|---|---|---|
| Mateen et al., 20066 | MDS, RAEB | 64/F | Dyspnea | Ejection fraction decrease Pericardial effusion | Blood transfusion | NA | Died |
| Matkowskyj et al., 20105 | t-MDS, RAEB | 59/M | Dyspnea | Acute heart failure Pericardial tamponade | Diuretic Intravenous dobutamine Pericardial drainage | No appearance of blasts | Died |
| Present case, 2020 | MDS | 80/M | Loss of consciousness | Pericardial tamponade | Pericardial drainage | Higher blasts ratio compared to peripheral blood | Died |