A Peculiar Case of Chronic Myelomonocytic Leukemia with Myelodysplastic Syndrome Overlap Presenting with Acute Renal Failure

Myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN) overlap syndromes is a relatively rare disease with a median survival of around 30 months. We presented a case report of a patient who was presented with acute renal failure in which initial diagnosis was confounded given lack of prior creatinine level leading suspicion of rapidly progressing glomerulonephritis. Additional confounding diagnosis were MAHA and autoimmune disorders given anemia and thrombocytopenia. Bone marrow biopsy with cytogenetics revealed the diagnosis of MDS/MPN- chronic myelomonocytic leukemia (CMML). Patient did have monocytosis on initial labs, and this finding should raise a suspicion of CMML in settings of anemia, thrombocytopenia and organ involvement. Timely treatment rapidly corrected and stabilized the cell counts leading to improvement in quality of life as frequent transfusions are no longer required.