Undiagnosed, untreated acute promyelocytic leukemia presenting as a suspicious sudden death.

Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia frequently associated with clotting abnormalities and severe hemorrhagic diathesis. The disease is associated with a high incidence of early fatal hemorrhage. We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis.

Spondylarthropathy striking prevalence in a 19th-20th century Portuguese collection.

UNLABELLED: The concept of spondylarthropathy (SPAP) covers a series of pathologies sharing a common genetic basis and infectious triggers. OBJECTIVES: To present and discuss the prevalence of SPAP in the Coimbra identified skeletal collection, a 19th-20th century Portuguese sample. MATERIALS AND METHODS: Each of the 505 individuals was macroscopically examined; each joint being assessed for degenerative, inflammatory, ankylosing, entesopathic, traumatic, congenital, infectious, or associated lesions. For the diagnosis of SPAP, besides the criteria proposed by Rogers and Rothschild, it was also applied a new set of criteria established by Martin-Dupont. Associated and differential diagnoses were also discussed. RESULTS: Using these latter criteria, SPAP was definitely diagnosed in 34 individuals (6.7%), mostly women and elderly individuals. Furthermore, SPAP was diagnosed as probable in 32 (6.3%) and could not be excluded in 98 skeletons (19.4%). Except for the third category, the results were close to those obtained when using the arguments of others authors. DISCUSSION: The specificity of each criterion is discussed, and the results are precautiously compared with other studies both from past and contemporary samples. Graduating the diagnosis as certain, probable or unexcluded, seems to us of interest, leading to etiological discussion as in clinical practice. CONCLUSION: The high prevalence of SPAP achieved for the Portuguese collection might be explained by high exposure to infectious triggers.