Acute limb ischemia in a child revealing acute myeloid leukemia: a case report and literature review

Abstract

Introduction and importance: Acute limb ischemia in children is rare and typically occurs secondary to trauma or iatrogenic injury. Arterial thrombosis as the initial manifestation of acute myeloid leukemia (AML) is exceptional. Early diagnosis is essential to prevent irreversible complications. Case presentation: We report the case of an 11-year-old boy with no prior medical history, admitted with acute right lower limb ischemia. Imaging revealed occlusion of the superficial femoral artery. Surgical management included double thromboembolectomy and femoropopliteal bypass. Laboratory investigations showed pancytopenia, and bone marrow biopsy confirmed AML. Despite prompt initiation of chemotherapy, the ischemia progressed, leading to above-knee amputation. Clinical discussion: Large-vessel arterial thrombosis as a presenting feature of AML in children is extremely rare. The hypercoagulable state associated with leukemia can lead to such vascular events. This case underlines the importance of considering hematologic malignancy in pediatric patients with unexplained acute limb ischemia. Conclusion: Acute limb ischemia can be the first sign of AML in children. Early multidisciplinary management is critical for improving survival and optimizing outcomes, although limb salvage is not always achievable.