sudden Death of SARS-CoV-2 patient with NPM1 + acute myeloid leukemia mimicking acute promyelocytic leukemia

NPM1‐mutated de novo acute myeloid leukemia (AML) is a heterogeneous group of disorders, including forms with monocytic or myeloid morphology and immunophenotype and several different comutational patterns. Recently, a new subset was described: It shows an APL‐like immunophenotype, with negativity for both CD34 and HLA‐DR, in the absence of a PML‐RARA translocation, with comutations in TET2 or IDH1/2. 1 This subset showed significantly longer relapse‐free survival and overall survival, as confirmed in a further study by the same group concerning 239 patients. 2 A 50‐year‐old man was admitted to our ER in September 2020 for fever and generalized bone pain, with a sudden onset while on vacation. Blood tests revealed severe neutropenia and moderate thrombocytopenia. A peripheral smear revealed 2% blasts with granules. Blood chemistry test showed increased levels of LDH and creatine kinase. Coagulation tests were normal, except for D‐dimer's abnormally high value (35 200 ng/mL—normal range < 500 ng/mL). EKG and troponin test were normal. Nasopharyngeal swab with molecular (PCR) tests for SARS‐CoV‐2 gave negative results. In agreement with local protocol, a total body CT scan was performed and ruled out pulmonary or abdominal complications.