Author: Hassan Nassar / Editor: Sarah Edwards / Codes: HC5, HP1, HP2, SLO3, SLO5 / Published: 05/11/2021

An 18-year-old female presents with fever (38.3ºC) and tachycardia (146bpm) following a worsening lesion of the outer aspect of her thigh that she noticed a week ago. She is unable to weight-bear on that limb. When her father checked google for similar images, he thought it would be spider bite. However, she does not recall being bitten.

Sepsis six is initiated within 30 minutes of her arrival. Co-amoxiclav is given initially.

On assessment, there are multiple bruises of different ages on both lower limbs that she noticed 2 weeks before and interpreted as injuries from jumping on the trampoline. It is also noted that her teeth braces are causing bleeding of the inner aspect of the lips along with a small upper lip haematoma that started 2 weeks earlier, and for which she has no explanation. On her back, there are 5 small circular bruises.

Her past medical history includs amenorrhoea due to primary ovarian insufficiency for which she is being investigated and congenital microtia of the right ear with an implanted prothesis. There is no family history of any blood disorders.

Her blood results show Hb 76 g/L, WCC 325×109/L, Neut 6.5, PLT 11×109/L, Lymph 16.3 x109/L, CRP 85 mg/L and INR 1.31.

Blood film is performed and confirms the diagnosis of AML with 89% blasts.

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