# Atypical Chest Pain Leading to the Diagnosis of Acute Promyelocytic Leukemia: A Case Report

## TL;DR

A 75-year-old woman with chest pain and shortness of breath was diagnosed with acute promyelocytic leukemia, a rare blood cancer, after ruling out heart issues.

## Contribution

This case report highlights atypical chest pain as an initial presentation of acute promyelocytic leukemia.

## Key findings

- The patient presented with chest pain and shortness of breath, not typical signs of acute coronary syndrome.
- Diagnosis of APML was confirmed through lab findings of leukocytosis, thrombocytopenia, and elevated D-dimer.
- Treatment with ATRA was initiated following the diagnosis.

## Abstract

Acute promyelocytic leukemia (APML) is a rare leukemia that leads to complications of renal toxicity, infections, leukocytosis, hemorrhaging, and disseminated intravascular coagulation, which is fatal. APML normally presents with bruising, bleeding, weakness, and infections. Patients can present with chest pain and shortness of breath due to coagulopathy. The workup for APML usually occurs when patients' labs return with leukocytosis and thrombocytopenia. Here, we report a case of a 75-year-old female with a past medical history of bronchiectasis, hypertension, and rheumatic fever who presented with chest pain and shortness of breath with elevated troponins and a normal EKG. The patient had worsened thrombocytopenia, leukocytosis, and an elevated D-dimer that did not resolve with steroids. The following report presents a patient diagnosed with APML with the initial symptoms of chest pain and shortness of breath without signs of acute coronary syndrome, leading to the diagnosis and treatment with ATRA.