ABSTRACT
JUSTIFICATIVA E OBJETIVOS: O acidente vascular encefálico (AVE) hemorrágico em pacientes jovens é potencialmente grave. Dentre as causas hematológicas, destaca-se a leucemia mieloide aguda, representada na maioria dos casos pela leucemia promielocítica aguda (M3), sendo escassos os relatos de AVE hemorrágicos como apresentação inicial em pacientes com leucemiamielo monocítica aguda (M4). O objetivo deste estudo foi relatar um caso de AVE hemorrágico como apresentação inicial de leucemia mielomonocítica em paciente jovem e discutir seus aspectos clínicos, evolutivos e terapêuticos. RELATO DO CASO: Paciente do sexo masculino, 19 anos,que apresentou diagnóstico de leucemia mielomonocítica aguda (M4) com hemorragia intraparenquimatosa cerebral, embora os níveis plaquetários fossem de 56.000/mm3. Foi submetido à drenagem do hematoma intraparenquimatoso. Recebeu tratamento quimioterápico com citarabina e idarrubicina em doses convencionais, evoluindo com distúrbios metabólicos, hidroeletrolíticose óbito no quinto dia de internação. CONCLUSÃO: A leucemia mieloide aguda deve fazer parte dos diagnósticos diferenciais da provável causa de AVE hemorrágico em jovens, inclusive naqueles com níveis plaquetários considerados relativamente "seguros", uma vez que este não é o único fator causal de sangramento.
BACKGROUND AND OBJECTIVES: The hemorrhagic stroke in young patients is potentially serious. Among the hematological causes, we highlight the acute myeloid leukemia, represented in most cases by acute promyelocytic leukemia, being few reports of hemorrhagic stroke as initial presentation in patients with acute myelomonocytic leukemia (M4). The objective of this study was to report a case of hemorrhagic stroke as the initial presentation of myelomonocytic leukemia in a young patient and discuss its clinical, evaluative and therapeutic aspects. CASE REPORT : Male patient, 19 years-old who had as initial presentation of acute myelomonocytic leukemia an intraparenchymal cerebral hemorrhage, with platelet levels of 56.000/mm3. The patient underwent drainage of hematomas. He received chemotherapy with idarubicin and cytarabine in conventional doses, evolving with metabolic disorders, acute renal failure and death on the fifth day of hospitalization. CONCLUSION : Acute myeloid leukemia should be part of the differential diagnosis of the probable cause of hemorrhagic strokein young patients, including those with platelet levels considered relatively "safe", since this is not the only causative factor forbleeding.
Subject(s)
Humans , Male , Adult , Leukemia, Myeloid, Acute , Leukemia, Myelomonocytic, Acute , Stroke , ThrombocytopeniaABSTRACT
La coexistencia de enfermedades mieloproliferativas y linfoproliferativas en el mismo paciente no es común. La mayoría de los casos corresponden a pacientes que desarrollan leucemia aguda durante el curso evolutivo de una leucemia linfática crónica tratada con drogas quimioterápicas. Se presenta un caso de leucemia mielomonocítica aguda y leucemia linfática crónica B diagnosticadas simultáneamente en un paciente en el cual, el análisis por citometría de flujo utilizando un amplio panel de anticuerpos monoclonales, permitió identificar las diferentes poblaciones patológicas y determinar su inmunofenotipo característico. Una revisión de la bibliografía muestra solamente la descripción de casos aislados sin encontrar datos sobre la incidencia de esta asociación. Destacamos la utilidad de la técnica de citometría de flujo para identificar las células anormales que nos llevan al diagnóstico de estas dos enfermedades.
The coexistence of acute myeloid leukemia and chronic lymphocytic leukemia in the same patient is rare. The majority of the cases correspond to patients that developed acute leukemia during the evolutionary course of a chronic lymphatic leukemia following treatment with chemotherapy drugs. We report a case of acute myelomonocytic leukemia concurrent with untreated B-cell chronic lymphocytic leukemia in which the use of flow cytometry analysis with a large panel of monoclonal antibodies, allowed the demonstration of different pathological populations and determine immunophenotyping patterns. Published cases of simultaneous chronic lymphocytic leukemia and acute leukemia are reviewed. The use of multiparametric flow cytometry to differentiate the populations demonstrates the utility of this technology in the diagnosis of these hematological malignancies.