Relapse of acute myeloid leukemia presenting as acute otitis media.

A 26-year-old female was diagnosed with acute myeloid leukemia (AML-M2 subtype with normal cytogenetics) 2 years previously. She was induced with conventional 3 : 7 induction chemotherapy (daunorubicin; cytosine arabinoside) and consolidated with three high doses of cytosine arabinoside. After chemotherapy, the patient remained in remission for 1.5 years. A written informed consent was obtained from her for publishing her report. The patient presented to us with a purulent discharge from her left ear of 1 month duration. She also gave a history of occasional headaches and otaligias. However, there was no history of trauma or recent upper respiratory tract infection. She denied history of diplopia, tinnitus, hearing loss, vertigo or any other neurological deficit. Otoscopic examination of the left ear revealed perforation in the tympanic membrane at 3’O clock position. However, no mass or choleseatoma was visualized. External auditory canal was normal and mastoid tenderness was absent. The patient was prescribed oral amoxycillin 500mg every 8 h along with topical antibiotics. However, there was no relief in her symptoms after 1 week of therapy. Investigations revealed hemoglobin of 12.3 gm/dl, TLC of 2300/mm and normal platelet count. Peripheral blood film did not reveal any blasts. CT head was done (Figure 1A and B) and revealed a soft tissue mass along the anterior aspect of left temporal bone extending into the middle ear cavity. Biopsy of the mass was done under local anaesthesia by an otolaryngologist. Histopathological examination (Figure 2A and B) revealed sheets of myeloblasts with varying degrees of differentiation, suggestive of granulocytic sarcoma (chloroma). Repeat bone marrow examination was suggestive of relapse with 42% myeloblasts.