Case Presentation: Sperm Banking in Patient Diagnosed with Acute Myeloid Leukemia

A 23-year-old man presented to a referring hospital emergency room with gradually worsening throat pain. He was febrile to 38.4°C and his exam was notable for very large, erythematous tonsils. His labs were notable for a white blood cell (WBC) count of 119.8 K/cu mm (3.50–10.80 K/cu mm) with 91% blasts, creatinine elevated to 1.63 mg/dL (0.70–1.30 mg/dL), and lactate dehydrogenase (LDH) of 1122 U/L (≤250 U/L). Computed tomography (CT) of the neck was remarkable for the enlargement of tonsils and lymph nodes with a narrowing of the nasopharyngeal airway. He was started empirically on cefepime and transferred to a tertiary care intensive care unit (ICU) due to concern for impending airway compromise in the setting of likely new acute leukemia. Upon arrival, his peripheral blood smear was notable for numerous circulating blasts with a high nuclear to cytoplasmic ratio, a moderate amount of basophilic cytoplasm, open chromatin, and prominent nucleoli suggestive of monoblastic differentiation. Flow cytometry confirmed an immunophenotype consistent with acute myeloid leukemia (AML).