# Acute Promyelocytic Leukemia Presenting as Spontaneous Abortion Amidst Tropical Fever Season: A Diagnostic Challenge

## TL;DR

A young woman with fever and vaginal bleeding was initially thought to have a miscarriage, but was later diagnosed with a rare type of leukemia.

## Contribution

Highlights the diagnostic challenge of APL presenting with gynecological symptoms and pregnancy loss.

## Key findings

- AML can present with gynecological symptoms in young females.
- Unexplained pancytopenia after pregnancy loss may indicate hematologic malignancy.
- Early bone marrow evaluation is crucial for prompt diagnosis of APL.

## Abstract

Acute myeloid leukemia (AML) is a hematologic malignancy with diverse and often nonspecific clinical manifestations. This report discusses a 30-year-old female presenting with fever for six days and per vaginal (PV) bleeding persisting for three days during the tropical fever season. Initial evaluation indicated pancytopenia, leading to considerations of infectious, nutritional, or hematologic etiologies. A detailed history revealed 10 weeks of amenorrhea with a positive urine pregnancy test (UPT) confirmed pregnancy, which was further supported by ultrasonography (USG), suggesting incomplete abortion. However, over the next few hours, she passed multiple clots per vagina, and a repeat USG confirmed that she had sustained a complete abortion. Despite multiple transfusions, pancytopenia persisted, prompting a bone marrow examination that confirmed acute promyelocytic leukemia (APL), a subtype of AML. This case underscores that unexplained pancytopenia persisting beyond seven days after pregnancy loss warrants early bone marrow evaluation to rule out hematologic malignancies, as AML can present with gynecological symptoms in young females and requires prompt diagnosis.