Kirby M A, Weitzman S, Freedman M H
Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada.
Am J Pediatr Hematol Oncol. 1990 Fall;12(3):292-6. doi: 10.1097/00043426-199023000-00007.
Differentiation between cytomegalovirus (CMV)-associated disease and juvenile chronic myelogenous leukemia (JCML) in infants excreting CMV may be difficult. It is important to make a prompt, definitive diagnosis since the management differs. A 3-month-old infant presented with clinical findings that mimicked both disorders and a plan was developed to make the correct diagnosis. Clonogenic assays and liquid cultures of patients' peripheral blood and bone marrow showed findings that are recognized as the hallmark of JCML, namely, impaired growth of normal hematopoietic progenitors, and excessive, autonomous proliferation of monocyte/macrophage elements. The urine was positive for CMV, and there was a significant rise in the anti-CMV antibody titer over 4 weeks, indicating a postnatal CMV infection. Despite this, freshly obtained and cultured marrow cells as well as a liver biopsy were negative for CMV by immunoassay, by anti-CMV monoclonal antibody testing, and by electron microscopy. Because of these results, the diagnosis of CMV infection was established but could not account for all of the abnormal clinical and hematological findings. Thus, the diagnosis of JCML was also substantiated and antileukemic therapy was initiated with confidence.
对于排出巨细胞病毒（CMV）的婴儿，鉴别CMV相关疾病和青少年慢性粒细胞白血病（JCML）可能存在困难。由于治疗方法不同，做出迅速、明确的诊断很重要。一名3个月大的婴儿出现了类似这两种疾病的临床表现，并制定了一个做出正确诊断的方案。对患者外周血和骨髓进行的克隆形成试验及液体培养显示出了被认为是JCML标志的结果，即正常造血祖细胞生长受损，以及单核细胞/巨噬细胞成分过度、自主增殖。尿液CMV检测呈阳性，且抗CMV抗体滴度在4周内显著升高，表明存在出生后CMV感染。尽管如此，通过免疫测定、抗CMV单克隆抗体检测及电子显微镜检查，新鲜获取并培养的骨髓细胞以及肝脏活检的CMV检测均为阴性。基于这些结果，CMV感染的诊断得以确立，但无法解释所有异常的临床和血液学表现。因此，JCML的诊断也得到了证实，并自信地开始了抗白血病治疗。
