Refractory right ventricular failure due to granulocytic sarcoma.

A 72-year-old white man had granulocytic sarcoma (chloroma) characterized by right ventricular failure. Seven years before his final hospitalization, a diagnosis of agnogenic myeloid metaplasia was made on bone marrow biopsy, and the patient was treated with phosphorus 32. Three months before his death, the patient developed refractory right ventricular failure. Biopsy of a mass in the anterior abdominal wall demonstrated granulocytic sarcoma. The patient died 10 days after the biopsy was performed. Autopsy showed disseminated granulocytic sarcoma with massive encasement of the heart and the great vessels. This finding can, in retrospect, explain the hemodynamic abnormalities that led to the patient's death. This is, to our knowledge, the first case report of granulocytic sarcoma diffusely involving the heart and causing refractory right ventricular failure in a patient with a long-standing history of agnogenic myeloid metaplasia.