We report a unique case of refractory acute myeloid leukemia (AML) precipitated by dengue virus induced marrow aplasia in a Chinese patient with hemoglobin (Hb) H disease. The quick temporal sequence of the three marrow abnormalities: hereditary hemoglobinopathy, reactive viral induced marrow change and malignant neoplastic process is highly unusual. Neither HbH disease nor viral induced marrow aplasia has known associations with AML. We propose that this unique case of AML may be caused by cytokine hyperstimulation in a stressed marrow.