One Disease, Multiple Hits: Acute Myeloid Leukemia With t(10;11) Presenting With Leukemic Lung Infiltration as First Presentation and Facial Nerve Palsy at Relapse.

Acute myeloid leukemia (AML) with t(10;11) is associated with poor outcomes. We report a rare case of monoblastic AML with mixed lineage leukemia (MLL) gene rearrangement t(10;11)(p11.2;q23) in a patient with extensive leukemic lung infiltration on his initial presentation leading to rapid deterioration following induction chemotherapy. Complete remission with negative cytogenetics was achieved following a limited induction due to acute respiratory failure. The patient subsequently relapsed with central nervous system involvement presenting with unliteral left lower motor neuron facial nerve palsy with cerebrospinal fluid positive for monoblasts.  Few unusual and challenging features were encountered with this patient including leukemic lung infiltration with extremely high lactate dehydrogenase (LDH) at the time of his initial presentation, rapid onset acute respiratory failure with no other identified causes within 48 hours of commencing induction chemotherapy. Additionally, achieving remission with only two days on induction chemotherapy and finally a stormy relapse with central nervous system involvement and left facial nerve palsy.