A female patient (N.H.) 70-years-old, married and having two children was admitted to the oncology department El Agouza police Hospital, Egypt on July 2018, She was diagnosed with Relapsed Acute Myeloid Leukemia (AML), with the following clinical presentation; fever, shortness of breath, frequent coughing, night sweats, joint pain and bruising, her ultrasound examination revealed mild splenomegaly, moreover, there was an evidence of endocrinology diagnosis with Type II Diabetes and Grade III

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... sity. Concerning the medication history, she had started Decitabine (Dacogen®) 3 months ago to be continued for another 3 months to follow her chemotherapeutic plan, also was on hydroxychloroquine and leflunomide (Avara®) past year for her rheumatoid arthritis, her laboratory results showed very low platelet count 50,000/mm cub, but normal complement C3 and C4 levels , 90 mg/dl and 30 mg/dl respectively. It was concluded that the use of Hydroxychloroquine in patients diagnosed with acute myeloid leukemia also suffering rheumatoid arthritis, may decrease their platelet count and increase the risk of bleeding, therefore, it is recommended to prescribe an alternative disease-modifying anti-rheumatic drugs (DMARDs).