Updyke Katelyn Mariko, Morales-Lappot Joan, Lee Theodore
College of Medicine, University of Central Florida.
Cureus. 2017 May 26;9(5):e1280. doi: 10.7759/cureus.1280.
Chronic myelogenous leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of the Philadelphia chromosome, t(9;22), which is a constitutively active tyrosine kinase that causes excessive proliferation and differentiation of myeloid cells in the bone marrow. Most patients are either asymptomatic or present with fatigue, abdominal fullness, and splenomegaly. This is a case in which a 72-year-old Caucasian male's initial presentation of CML was new-onset atrial fibrillation, chronic obstructive pulmonary disease (COPD) exacerbation, and pneumonia. The severity of his symptoms of atrial fibrillation and dyspnea complicated his stabilization, which delayed his diagnosis of CML and initiation of tyrosine kinase inhibitor for treatment. Unregulated proliferation of leukemic cells increases blood viscosity and results in aberrations in blood circulation that may result in atypical presenting symptoms in myeloproliferative disease. Thus, it is important to have a high clinical index of suspicion for CML in patients with leukocytosis and concurrent symptomatology that is unusual for leukemia.
慢性粒细胞白血病（CML）是一种克隆性骨髓增殖性疾病，其特征是存在费城染色体，即t(9;22)，这是一种组成型活性酪氨酸激酶，可导致骨髓中髓系细胞过度增殖和分化。大多数患者无症状或表现为疲劳、腹部胀满和脾肿大。这是一例72岁白人男性，其CML的初始表现为新发房颤、慢性阻塞性肺疾病（COPD）加重和肺炎。他的房颤和呼吸困难症状的严重程度使病情稳定复杂化，这延迟了他的CML诊断和酪氨酸激酶抑制剂治疗的启动。白血病细胞的不受控制增殖会增加血液粘度，并导致血液循环异常，这可能导致骨髓增殖性疾病出现非典型症状。因此，对于白细胞增多且伴有白血病不常见并发症状的患者，高度怀疑CML具有重要的临床意义。
