Acute promyelocytic leukemia with tetraploid karyotype and multiple PML-RARA fusion signals

A woman in her thirties was admitted to our hospital for severe pain on the right side of the lower abdomen. Computed tomography demonstrated diverticulitis of the ascending colon associated with regional peritonitis. As a blood test disclosed leukocytopenia, she was referred to the hematology department on the next day of admission. Her hemoglobin level was 10.3 g/dL, white cell count was 0.83 × 10 3/μL, and platelet count was 67 × 10 3/μL. Her uric acid level was 2.8 mg/dL, total protein level was 5.6 g/dL, albumin level was 3.0 g/dL, lactate dehydrogenase level was 320 U/L, C-reactive protein level was 5.26 mg/dL, and procalcitonin level was 2.9 ng/mL. The prothrombin time was 22.3 sec, activated partial thromboplastin time was 38.3 sec, fibrinogen level was 37 mg/dL, antithrombin III level was 67% (reference, 70-125%), fibrin degradation product level was 260.0 μg/mL, D-dimer level was 83.0 μg/mL, and soluble fibrin monomer complex level was 95.4 μg/mL (reference, < 7 μg/mL). Examination of the bone marrow (BM) revealed marked hypercellularity with 88.9% leukemia cells.