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Acute myeloid leukemia (AML) M6 or acute erythroid leukemia is an extremely rare
type of leukemia and in children is even rarer (about 0.5???4.6% of all cancer-affected
individuals are children). We report a case of a 2-year-old boy who started complaints
of pain in the lower left leg, more specifically at the tibio-tarsal joint (site of fracture
one 1 year before), with progressive aggravation, imbalance in gait and associated with
B symptoms, which motivated the mother to seek medical assistance. Analytical study
documented anemia of 10.7 g/dL, leukocytes of 10570 /uL, thrombocytopenia of 69000
/ uL and DHL of 585 U/L. Objective examination was normal apart from imbalance in
gait. Parvovirus serology was negative. In subsequent analyzes 3% blasts of the erythroid
line were detected in the peripheral blood. Medullary aspirate was difficult to perform,
and the first samples were very hypocelular. Immunophenotyping of bone marrow
showed in the beginning 4% of erythroblasts, then 1%, 3% and 0.09% in subsequent
samples. Bone marrow biopsy showed involvement by acute leukemia with erythroblastic
differentiation. Cytogenetics of bone marrow demonstrate a complex karyotype. There
was no infiltration of central nervous system. In spite of a low percentage of blasts in the
bone marrow, and given that there was a diagnosis by pathological anatomy and a notion
of clinical worsening (the child was very asthenic and with generalization of bone pain), it
was decided to start treatment according to NOPHO AML 2012 protocol. Treatment was
finished in March 2017 with complete response.
Carolina Maria Costa Pavão has completed her MD with master degree in 2014 from the Faculty of Medicine of the University of Coimbra. Started her residency in clinical hematology in the hematology service of the Hospital do Divino Espírito Santo, Ponta Delgada, Portugal, in January of 2016, being currently attending the third year of her specific five year formation. As part of this programme she completed an intership in oncology pediatrics at Porto Oncology Institute in 2018.