• Jiamei Ji, Yating Li, Lei Fan, Hua Lu, and Xiaoyan Qu.
• Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Key Laboratory of Hematology of Nanjing Medical University.
• Medicine (Baltimore). 2021 Apr 16; 100 (15): e25528e25528.

RationalePure erythroid leukemia is a rare subcategory of acute myeloid leukemia characterized by predominant immature erythroid population. Its occurrence subsequent to acute myelomonocytic leukemia has not been reported before. We reported this rare case to call attention because it may pose a diagnostic challenge.Patients ConcernsA 54-year-old female patient presented to our hospital in March 2018 with symptoms of easy fatigability.DiagnosisBone marrow aspiration was hypercellular showing 67.2% blasts mainly including moderate myeloblasts and monoblasts. There was mild dysplasia with some cells having round, oval, or bizarre nuclei which containing 1 to 3 nucleolus. Erythroid lineage was hypoplasia and mature erythrocytes were generally normal. Conventional cytogenetics of bone marrow cells revealed complex karyotype (44, XX, del (5) (q14q34) del (5) (q14q34), del (14) t (11;14) (q10; q10), -16, del (17), -18[10]).InterventionsThe patient was treated with second line chemotherapy but did not respond.QutcomesShe died of cardiopulmonary failure 19days after starting of therapy.LessonsThis unexpected and relatively uncommon occurrence was associated with a universally rapid and fatal clinical course with survival measured in <2 months despite intensive chemotherapy. We call attention to this rare phenomenon because it may pose a diagnostic challenge.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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