PMC10126291_01
A typical promyelocytes with rare Auer rods, bilobed and reinform nucleus (MCG, x100).
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October 1st, 2021. On admission, his total white blood cell count (WBC) was 137.53 x 109/L with 92% atypical promyelocytes on the peripheral blood smear, hemoglobin 12.6 g/dL, and platelet count 45 x 109/L ( Figure 1 ,  Table 1 ). On day 48 since the start of induction treatment our patient was discharged, having achieved morphologic complete remission and no longer presenting any cardiac or infections symptoms ( Figure 3 ,  Table 1 ).
Cardiac MRI: delayed MRI enhancement sequence using the short-axis (A) highlights two contrast upateks with mid-myocardial and sub-epicardial topography at the level of the infero-septal and inferior wall of the left ventricle (white arrows) which correspond to focal ares of mycocardial edema visible in T2 weighted image with fats saturation (B) white arrows, suggesting acute myocarditis.
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Myocarditis was later confirmed by cardiac magnetic resonance imaging performed 11 days after the onset of cardiac symptoms, which found focal edema within the septum, with prolonged myocardial relaxation times in T1-weighted mapping (1098 ms, normal range 885-1059) and T2 mapping (73 ms, normal range 45-65),a left ventricular ejection fraction(LVEF)of 50%, extracellular volume (ECV) 40% ( Figure 2 ).
Timeline of clinical course of our patient from the day of admission to the day of discharge. During induction the patient experienced differentiation syndrome and covid-19 myocarditis, which required complex therapeutic approaches. DS, differentation syndrome; ivIg, intravenous immunoglobulin; CR, complete remission. Created with .
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On day 48 since the start of induction treatment our patient was discharged, having achieved morphologic complete remission and no longer presenting any cardiac or infections symptoms ( Figure 3 ,  Table 1 ).