2022 Volume 63 Issue 9 Pages 409-416
A man in his 40s was admitted to our hospital for cerebral hemorrhage with pancytopenia. The bone marrow was slightly hypoplasia without evidence of myeloproliferative neoplasms. Upper gastrointestinal endoscopy detected esophageal and duodenal varices. Abdominal ultrasonography showed a positive portal sandwich sign around the portal vein. Abdominal computed tomography showed no evidence of cirrhosis or portal vein obstruction but showed an enlarged left lobe of the liver and splenomegaly. A portal pressure gradient (16 mmHg) was observed. A hematologic disease was suspected again because pancytopenia worsened after a partial splenic artery embolization. Bone marrow examination revealed de novo acute myeloid leukemia. Although portal hypertension has been reportedly associated with myeloproliferative diseases, such as primary myelofibrosis, it has never been reportedly complicated with de novo acute myeloid leukemia.