An 80-year-old man with acute panmyelosis with myelofibrosis: A rare subtype of acute myeloid leukemia

Acute panmyelosis with myelofibrosis (APMF) is a rare, fatal hematological neoplasm that is characterized by acute onset of cytopenias and fibrosis in the bone marrow in the absence of splenomegaly or fibrosis-related morphological changes in the red blood cells. We report the case of an 80-year-old male who presented with progressive pallor and weakness of 1-month duration. Peripheral smear revealed severe anemia, leukopenia with occasional circulating blasts and a normal platelet count. The marrow was heavily fibrotic, and no aspirate material could be obtained; the biopsy showed extensive infiltration with small to medium size megakaryocytes, dysplastic changes in the erythroid compartment, and focal clusters of blasts. A diagnosis of APMF was made and the patient was started on low dose lenalidomide and supportive transfusions. However, the patient died due to intracranial bleeding. Cases of APMF have a dismal outcome and should be managed aggressively.