ABSTRACT
Se reporta un caso clínico de un paciente masculino de 65 años, que ingresó al hospital por cuadro de 10 días de evolución, con sospecha clí- nica y de laboratorio de un síndrome mieloproliferativo. Estudiado por hematología, se confirmó Leucemia Mieloide Aguda M5. Se inició quimioterapia de inducción. El paciente evolucionó con pancitopenia, destacando neutropenia severa hasta 200 /mm3, febril y sin foco precisado. Se trató con antibióticos de amplio espectro por 10 días con buena respuesta. Cinco días después de finalizar su tratamiento antibiótico, nuevamente comenzó con fiebre, alza de parámetros inflamatorios, neutropenia severa y clínica de foco respiratorio. Se realizó Tomografía Computada (TC) de tórax y galactomanano en sangre, ambos compatibles con aspergilosis pulmonar, por lo que se inició tratamiento con voriconazol. El paciente evolucionó con buena respuesta clínica y de laboratorio, mejoría de imá- genes del TC de tórax y negativización de galactomanano. Al mes cedió la pancitopenia. Fue dado de alta en buenas condiciones generales, con indicación de volver a hospitalizar para quimioterapia de consolidación.
A report of a clinical case of a male patient aged 65 is presented. He entered to the hospital for 10 days evolution box with clinical and laboratory suspicion of a myeloproliferative syndrome. Studied by hematology, acute myeloid leukemia M5 was confirmed. induction chemotherapy began. The patient developed pancytopenia, highlighting severe neutropenia up to 200 / mm3, fever and without pointed focus. He was treated with broadspectrum antibiotics for 10 days with good response. Five days after finishing his antibiotic treatment began with fever again, rising inflammatory parameters, neutropenia and severe respiratory clinical focus. Computed Tomography (CT) of the chest and blood galactomannan was realized, both were compatible with pulmonary aspergillosis, starting treatment with voriconazole. The patient developed good both clinical and laboratory, improvement in chest CT images and negativization galactomannan response. Month later yielded pancytopenia. He was discharged in good general condition, indicating again been hospitalized for consolidation chemotherapy.
Subject(s)
Humans , Male , Aged , Aspergillus/pathogenicity , Invasive Pulmonary Aspergillosis/diagnostic imaging , Invasive Pulmonary Aspergillosis/etiology , Invasive Pulmonary Aspergillosis/blood , Invasive Pulmonary Aspergillosis/drug therapy , Leukemia, Myeloid, Acute/complications , Leukemia, Monocytic, Acute/complications , Neutropenia , Tomography, X-Ray Computed/methodsABSTRACT
The incidence of acute leukemia in children with Down syndrome (DS) is high as compared to general population. Recent findings have demonstrated that DS children with acute myeloid leukemia (AML) have the highest event free survival rates with high dose cytosine arabinoside (Ara-C). We present 3 year-old DS female child with AML-M5, whose chromosomal analysis revealed constitutional t(21;21) alongwith del(5)(q31q33) and a unique translocation t(16;20)(q13;q12). After chemotherapy, child achieved complete clinical remission. Karyotype analysis of remission marrow showed disappearance of abnormal clone of der(20) t(16;20)(q13;q12), del(5q) indicating cytogenetic remission too. This case alongwith supportive literature indicate that pediatric DS-AML is a distinct biologic sub-group differs from that of non-DS-AML with respect to chemosensitivity.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Child, Preschool , Chromosome Aberrations , Chromosome Deletion , Cytarabine , Daunorubicin/administration & dosage , Down Syndrome/complications , Female , Humans , Leukemia, Monocytic, Acute/complications , Thioguanine , Translocation, GeneticABSTRACT
We report an autopsy case of congenital monoblastic leukemia that developed in monozygotic twins. The twin presented with progressive hepatosplenomegaly at 4 weeks after birth. One twin died of massive bleeding and hypovolemic shock before the treatment started. At autopsy, the liver was diffusely enlarged and showed a diffuse whitish discoloration except for the subcapsular and perivenular areas. Microscopic examination disclosed infiltration of histiocyte-like atypical cells along the sinusoids and portal areas of the liver. Spleen, lymph nodes and choroid plexus were also infiltrated by the tumor cells. However, bone marrow involvement of the tumor was minimal although multifocal. On immunohistochemical staining, these atypical cells were reactive for CD68 (PGM-1) and lysozyme, suggesting that the tumor cells might have been derived from mono- histiocyte. Cytogenetic study revealed 9;11 translocation, which is frequently associated with acute monoblastic leukemia. To the best of our knowledge, this is the first report of congenital monoblastic leukemia of monozygotic twins in Korea.
Subject(s)
Female , Humans , Infant, Newborn , Chromosomes, Human, Pair 11 , Chromosomes, Human, Pair 9 , Diseases in Twins/genetics , Fatal Outcome , Hepatomegaly/complications , Leukemia, Monocytic, Acute/complications , Liver/pathology , Splenomegaly/complications , Translocation, Genetic , Twins, Monozygotic/geneticsABSTRACT
We report on an 18-year-old man who had both acute monoblastic leukemia and Marfan syndrome. A diagnosis of Marfan syndrome was established by those characteristics of arachnodactyly, ectopia lentis, mitral valve prolapse, and mitral regurgitation. Findings on bone marrow examination of the patient showed that most of nucleated cells were monoblasts and immunophenotype of those cells showed CD13+, CD33+, CD56+, and HLA-DR+. To our knowledge, this is the second report of leukemia in Marfan syndrome in the world.
Subject(s)
Humans , Male , Adolescent , Biopsy, Needle , Bone Marrow/pathology , Diagnosis, Differential , Echocardiography , Electrocardiography , Leukemia, Monocytic, Acute/diagnosis , Leukemia, Monocytic, Acute/complications , Marfan Syndrome/diagnosis , Marfan Syndrome/complicationsABSTRACT
A 54-year-old man who had acute monoblastic leukemia and manifestations of subacute combined degeneration (SCD) of the spinal cord is described clinically and pathologically. Infiltration of the wall of the stomach by leukemic cells may produce impairment in gastric absorption of vitamin B12 and leukemia itself may cause deficiency of folic acid. Decreased level of vitamin B12 or folic acid or both may have evoked symptoms of SCD of the spinal cord in this patient.
Subject(s)
Demyelinating Diseases/complications , Humans , Leukemia, Monocytic, Acute/complications , Male , Middle Aged , Pyramidal Tracts/pathology , Spinal Cord Diseases/complicationsABSTRACT
Trabalhos sobre leucemia aguda têm demonstrado a presença de neuroleucemia em 50%, até 70%, dos pacientes; porém um trabalho recente indica diminuiçäo na incidência da neuroleucemia para apenas 15%. O propósito deste trabalho foi o de verificar a incidência de neuroleucemia nos pacientes com leucemia aguda estudados na Escola Paulista de Medicina no período de outubro de 1982 a maio de 1984. O material deste estudo foi constituído pelas observaçöes de 28 pacientes com leucemia aguda. Nenhum destes pacientes, por ocasiäo da coleta de líquido cefalorraquidiano, apresentava sinais ou sintomas neurológicos. O estudo citológico foi feito em todas as amostras de líquido cefalorraquidiano. Este estudo permitiu verificar a presença de células blásticas em 47% dos pacientes estudados. As células blásticas foram observadas em 31 amostras, 19 delas com número global de células normal. A percentagem de células blásticas presentes variou de 0,5% a 96%. Estes resultados permitem concluir que em 47% dos pacientes houve comprometimento pré-clínico do sistema nervoso e que é fundamental o exame citológico do líquido cefalorraquidiano na avaliaçäo do paciente leucêmico desde a fase inicial de diagnóstico e tratamento