Harada Naonori, Nakane Takahiko, Okamura Hiroshi, Nanno Satoru, Nakashima Yasuhiro, Koh Hideo, Tanaka Sayaka, Ohsawa Masahiko, Hino Masayuki, Nakamae Hirohisa
Hematology, Graduate School of Medicine, Osaka City University.
Department of Diagnostic Pathology, Graduate School of Medicine, Osaka City University.
Rinsho Ketsueki. 2020;61(1):27-32. doi: 10.11406/rinketsu.61.27.
A 65-year-old woman was urgently admitted to our hospital for antibiotic-resistant fever, hypoxemia, and hyperleukocytosis and was diagnosed with acute monoblastic leukemia. Chest computed tomography revealed interlobular septal thickening, central ground-glass opacity, and a nodular shadow in the left lower lobe. Although several treatments for infectious disease and acute heart failure were administered, they were less effective. Transbronchial lung biopsy was performed on day 7 of hospitalization, and subsequently, pulmonary leukemic infiltration was confirmed. Based on the diagnosis, we decided to start intensive chemotherapy. Consequently, the abnormal lung shadow on computed tomography vanished, and complete hematological remission was achieved. Although acute myeloid leukemia is frequently associated with lung infiltration during onset, it is often difficult to distinguish it from other pulmonary complications. In clinical practice, intensive chemotherapy is often initiated based on the clinical evaluation without pathological confirmation of the lung disease. Our patient was accurately diagnosed based on the pulmonary leukemic infiltration observed pathologically and recovered well. Here we report our case along with a discussion of the relevant literature.
一名65岁女性因耐抗生素发热、低氧血症和白细胞增多症紧急入住我院，被诊断为急性单核细胞白血病。胸部计算机断层扫描显示小叶间隔增厚、中央磨玻璃影和左下叶结节状阴影。尽管给予了多种治疗传染病和急性心力衰竭的方法，但效果不佳。住院第7天进行了经支气管肺活检，随后证实了肺部白血病浸润。基于该诊断，我们决定开始强化化疗。结果，计算机断层扫描上的异常肺影消失，实现了完全血液学缓解。虽然急性髓细胞白血病在发病期间常伴有肺部浸润，但通常很难将其与其他肺部并发症区分开来。在临床实践中，往往在没有肺部疾病病理证实的情况下，根据临床评估就开始强化化疗。我们的患者通过病理观察到的肺部白血病浸润得到了准确诊断，并且恢复良好。在此我们报告该病例并对相关文献进行讨论。
