Relapsing Leukemia Infiltrating the Heart

Large granular lymphocyte (LGL) leukemia is a chronic indolent leukemia. Microscopic evidence of cardiac involvement by leukemia is found in ≈30% to 40% of patients who have died of the disease.1 Most of the times it is diagnosed because of cardiac complications, such as pericardial effusion.2 A 21-year-old woman with history of lymphoproliferative T-cell disease (LGL leukemia CD4+) while on therapy with low dose methotrexate and corticosteroid was admitted to the Emergency Department with anasarca. LGL leukemia had been previously diagnosed by morphological, immunophenotypic, and molecular analysis of blood and bone marrow biopsy. An electrocardiogram showed sinus tachycardia with infero-lateral T-wave inversions. High-sensitivity troponin I was normal. Physical examination was notable for bilateral pleural effusions, hepato-splenomegaly, and ascites. Pulmonary embolism was ruled out by computed tomographic …