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Accidental diagnosis: Aeromonas infection leading to discovery of acute myeloid leukemia with meylodysplastic syndrome.

PATIENT
47-year-old African American man.


CHIEF COMPLAINT
Initially, serious finger abscess. The patient reported severe pain that was localized to that finger only.


HISTORY OF PRESENT ILLNESS
His finger had become sore and then progressively more painful and swollen.


PAST MEDICAL HISTORY
A few weeks earlier, the patient had had a similar abscess on his leg; he could not recall any specific injuries other than this. He had a past history of epilepsy that is totally unrelated to this case; he had not had any episodes in more than 10 years. Otherwise, the medical history of the patient was relatively healthy: he is a nonsmoker with no history of diabetes or steroid use.


SOCIAL HISTORY
Patient washed cars for a living.


FAMILY HISTORY
Noncontributory.


PHYSICAL EXAMINATION
Initially, the patient was sent home with a course of antibiotics (cephalexin and trimethoprim/sulfamethoxazole) and was asked to return to the hospital for follow up within two days. By the time of the follow-up visit, the antibiotic treatment had been unsuccessful, and the patient experienced more pain in the finger; the flesh of the finger was becoming black and necrotic. The patient tested positive for all myeloid markers: myeloperoxidase (MPO), CD34, CD33, CD13, CD45, human leukocyte antigen–DR subregion (HLA-DR), CD15, and CD11c. Trilinear dysplasia was indicated by the results of bone-marrow studies and peripheral blood smear testing.