COVID-19 e o exame do líquor / COVID-19 and Cerebral Spinal Fluid analysis

O novo coronavírus (SARS-Coronavírus-2: SARS-Cov-2) foi inicialmente relatado em 2019, em Wuhan, China, onde o aparecimento de muitos casos inexplicáveis de pneumonia severa deixou em alerta todos os serviços de saúde do mundo. A Organização Mundial da Saúde (OMS) declarou recentemente uma pandemia, com mais de um milhão de casos relatados até o momento de COVID-19. A relação da fisiopatologia deste novo agente infeccioso associado ao comportamento dos achados laboratoriais do exame do líquor-LCR, através das descrições de casos e relatos, é importante para a análise, interpretação e apoio diagnóstico.

The new coronavirus (SARS-Coronavirus-2: SARS-Cov-2), was initially reported in 2019 in Wuhan, China, where the appearance of many unexplained cases of severe pneumonia has put all health services on alert of the world. The World Health Organization (WHO) recently declared a pandemic, with more than 1,000,000 cases reported to date as of COVID-19. The pathophysiological relationship of this new infectious agent associated with the behavior of laboratory findings of Cerebrospinal Fluid (CSF) examination, through case descriptions and reports, are important for analysis, interpretation and diagnostic support.

Chronic myeloid leukemia blast crisis presented with AML of t(9;22) and t(3;14) mimicking acute lymphocytic leukemia.

BACKGROUND: Clinically, 90%-95% of cases of CML have the characteristic t(9;22) (q34.1;q11.2) translocation that leads to the Philadelphia (Ph) chromosome. Rarely, patients with CML can present directly in a blast crisis (BC). While most blast crises are of myeloid origin, myeloid BC with ALL-like morphologic features and Ph-positive acute myeloid leukemia (AML) is rare, especially at the time of CML diagnosis. CASE PRESENTATION: A 20-year-old man presented with Ph chromosome-positive AML mimicking acute lymphocytic leukemia (ALL). Bone marrow (BM) aspiration revealed AML with ALL-like morphologic features. The results of the immunophenotypic analysis suggested AML. Cytogenetic analysis of the BM cells revealed a 46,XY,t(3;14)(q21;q32),t(9;22)(q34;q11.2)[20] karyotype. Thus, we called the condition AML mimicking ALL. The patient was diagnosed with myeloid BC based on the combination of clinical, cytologic, and cytogenetic studies. CONCLUSION: To date, no case reports of a patient diagnosed with CML BC presented with Ph chromosome-positive AML mimicking ALL have been reported. We present the case given its rarity, easy misdiagnosis, and poor prognosis. It is important to combine clinical, cytologic, and cytogenetic analyses in distinguishing CML BC from de novo AML with the t(9;22)，and further cases should be accumulated to explore how to improve the prognosis of the patients.