Tokuyama Takahito, Muta Tsuyoshi, Yasunaga Megumi, Nakanishi Hideyuki, Ueda Yoko, Fujisaki Tomoaki
Department of Internal Medicine, Matsuyama Red-Cross Hospital, Japan.
Gan To Kagaku Ryoho. 2011 Oct;38(10):1733-7.
A 67-year-old man developed a diffuse large B-cell lymphoma, and was simultaneously diagnosed as myelodysplastic syndrome(refractory cytopenia with multilineage dysplasia). Acute lung injury was complicated after the 6th course of rituximab injection, but was recovered by steroid pulse therapy. At that moment, marked leucocytosis was prominent due to the disease progression of myelodysplastic syndrome. Two months later, he relapsed into lymphoma systematically. During salvage chemotherapy without rituximab, the patient deteriorated into lethal respiratory failure. Autopsy findings revealed the diffuse alveolar damage with microscopic evidence of an adenovirus infection. His bone marrow showed the transformation of myelodysplastic syndrome into acute myeloid leukemia. The coincidence of myeloproliferative and lymphoproliferative diseases in the same patient is a rare phenomenon. We should be cautious when acute lung injury occurs during such a condition.
一名67岁男性患弥漫性大B细胞淋巴瘤，同时被诊断为骨髓增生异常综合征（难治性血细胞减少伴多系发育异常）。在第6疗程注射利妥昔单抗后并发急性肺损伤，但经类固醇冲击治疗后恢复。当时，由于骨髓增生异常综合征病情进展，出现明显的白细胞增多。两个月后，他全身淋巴瘤复发。在无利妥昔单抗的挽救化疗期间，患者病情恶化为致命性呼吸衰竭。尸检结果显示弥漫性肺泡损伤，并有腺病毒感染的微观证据。他的骨髓显示骨髓增生异常综合征转化为急性髓系白血病。同一患者同时出现骨髓增殖性疾病和淋巴增殖性疾病的情况较为罕见。在此种情况下发生急性肺损伤时，我们应谨慎对待。
