sudden Death of a sars cov 2 patient with NPM1 + acute myeloid mimicking acute promyelocytic leukemia

NPM1‐mutated de novo acute myeloid leukemia (AML) is a heterogeneous group of disorders, including forms with monocytic or myeloid morphology and immunophenotype and several different comutational patterns. Recently, a new subset was described: It shows an APL‐like immunophenotype, with negativity for both CD34 and HLA‐DR, in the absence of a PML‐RARA translocation, with comutations in TET2 or IDH1/2.1 This subset showed significantly longer relapse‐free survival and overall survival, as confirmed in a further study by the same group concerning 239 patients.2 A 50‐year‐old man was admitted to our ER in September 2020 for fever and generalized bone pain, with a sudden onset while on vacation. Blood tests revealed severe neutropenia and moderate thrombocytopenia. A peripheral smear revealed 2% blasts with granules. Blood chemistry test showed increased levels of LDH and creatine kinase. Coagulation tests were normal, except for D‐dimer's abnormally high value (35 200 ng/mL—normal range < 500 ng/mL). EKG and troponin test were normal. Nasopharyngeal swab with molecular (PCR) tests for SARS‐CoV‐2 gave negative results. In agreement with local protocol, a total body CT scan was performed and ruled out pulmonary or abdominal complications. Bone marrow smear showed pathological hypergranular blasts similar to leukemic promyelocytes, but in the absence of Auer rods, and a minority of agran