PMC8488243_01
Chest computed tomography (a) on admission and (b) at the time of acute respiratory failure onset in Case 1. Fig. 1c shows flow cytometry of pleural effusion at autopsy in Case 1. Fig. 1d-g shows histopathologic examination of lung tissue at autopsy in Case 1 (d; HE, x 40, e; HE, x 400, f; MPO, x 40, g; MPO, x 400). HE, hematoxylin-eosin; MPO, myeloperoxidase.
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An admission chest computed tomography (CT) scan yielded normal findings (Fig. 1a). On day 19, he developed ARF, with chest CT scan showing ground-glass opacities and septal thickening in the bilateral lung fields (Fig. 1b). Flow cytometry of the pleural effusion revealed a myeloblast population showing CD34+/HLA-DR.+/CD13+ expression (Fig. 1c). Further, there was organization of a hyaline membrane-like substance, which was consistent with the findings of diffuse alveolar damage (Fig. 1d, e). Immunohistochemical (IHC) staining revealed extensive myeloperoxidase (MPO)-positive blast infiltration and PLI (Fig. 1f, g).
PMC8488243_02
Chest computed tomography on admission (a) and chest X-ray done at the time of acute respiratory failure onset (b) in Case 2. Histopathologic examination at autopsy in Case 2. Fig. 2c-f shows HE staining of the lung (c; HE x 40, d; HE x 400, e; MPO x 40, f; MPO x 400). Fig. 2g-j shows leukemic infiltration in the spleen (g; HE x 40, h; HE x 400). Fig. 2i-j shows in the liver (i; HE x 40, j; HE x 400). HE, hematoxylin-eosin; MPO, myeloperoxidase.
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An admission chest CT scan revealed patchy ground-glass infiltration in the right lower lung field (Fig. 2a). However, on day 4 of induction chemotherapy, he developed ARF; further, chest radiography revealed bilateral lung field infiltration predominantly in the right lung (Fig. 2b). In the lung tissue, HE staining revealed blast infiltration; additionally, IHC staining revealed extensive MPO-positive blast infiltration and PLI (Fig. 2c-f). Furthermore, there was leukemic infiltration in the liver and spleen (Fig. 2g-j).