Chronic Myeloid Leukemia (CML) Complicated by Mixed Malaria Infection- An Unusual Presentation

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Chronic Myeloid Leukemia (CML) Complicated by Mixed Malaria Infection- An Unusual Presentation

Kanwal Zahra and Lubna Naseem,
Department of Pathology, Pakistan Institute of Medical Sciences

Abstract
Objective: To report an unusual case of Chronic Myeloid Leukemia (CML) undergoing chemotherapy complicated by co- infection with Plasmodium vivax and Plasmodium falciparum.
Case presentation: A 31 years Kashmiri male who was a known case of Philadelphia positive Chronic Myeloid Leukemia and on chemotherapy for last1 year, presented with high grade fever, left flank pain, vomiting and one episode of epistaxis. The oncologist suspected CML progressing to Accelerated phase or chemotherapeutic drug (Tasigna) associated adverse effects leading to thrombocytopenia. He was diagnosed with mixed malarial infection based on positive blood smear and bone marrow aspirate showing gametocytes of both Plasmodium Vivax and Plasmodium Falciparum. Patient was treated successfully with anti malarial drugs and showed marked improvement in platelet count.
Conclusion: It is suggested that malaria should be considered as a complicating factor in the patients of hematological malignancies or those on chemotherapy in form of fever or thrombocytopenia, especially in malaria- endemic areas.
Keywords: Chronic Myeloid Leukemia (CML), Plasmodium vivax, Plasmodium falciparum, Thrombocytopenia.

         

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