Osaki Masahide, Lee Yoonha, Osamura Yoko, Ichiki Tomoe, Okabe Motohito, Kawaguchi Yuka, Obiki Marie, Ito Ai, Goto Miyo, Araie Hiroaki, Goto Tatsunori, Morishita Takanobu, Ozawa Yukiyasu, Ito Masafumi, Miyamura Koichi
Department of Hematology, Japanese Red Cross Nagoya First Hospital.
Division of Laboratory, Japanese Red Cross Nagoya First Hospital.
Rinsho Ketsueki. 2020;61(3):257-261. doi: 10.11406/rinketsu.61.257.
A 54-year-old man with acute myeloid leukemia (AML) underwent allogeneic bone marrow transplantation from a human leukocyte antigen-matched unrelated donor in nonremission status. Bone marrow aspiration performed on day 14 showed that the patient had achieved complete remission; however, he relapsed on day 28. The patient developed a wet cough, and chest computed tomography performed on day 27 revealed pneumonia. Because pneumonia developed along with the leukemic relapse, we suspected that it was due to pulmonary leukemic infiltration (PLI). Giemsa-stained sputum showed some blast cells and fluorescence in situ hybridization indicated that the patient had monosomy 7, which was also detected in bone marrow blasts. Though we prescribed hydroxycarbamide and decreased tacrolimus rapidly, AML progressed and led to the patient's death on day 45. Histopathological findings of the autopsy performed the next day showed diffuse alveolar damage in both lungs. The blast cells were packed in blood vessels of alveolar septa and were also seen in alveoli. PLI was diagnosed pathologically. In conclusion, our case demonstrates that Giemsa stain of sputum is useful in quick diagnosis of PLI without invasive examination.
一名54岁的急性髓系白血病（AML）男性患者，在未缓解状态下接受了来自人类白细胞抗原匹配的无关供体的异基因骨髓移植。移植后第14天进行的骨髓穿刺显示患者已完全缓解；然而，他在第28天复发。患者出现湿性咳嗽，第27天进行的胸部计算机断层扫描显示患有肺炎。由于肺炎与白血病复发同时出现，我们怀疑这是由于肺部白血病浸润（PLI）所致。吉姆萨染色的痰液显示有一些原始细胞，荧光原位杂交表明患者存在7号染色体单体，骨髓原始细胞中也检测到了该情况。尽管我们开具了羟基脲并迅速减少了他克莫司的用量，但AML仍进展并导致患者在第45天死亡。次日进行的尸检组织病理学检查结果显示双肺均有弥漫性肺泡损伤。原始细胞聚集在肺泡间隔的血管中，也可见于肺泡内。经病理诊断为PLI。总之，我们的病例表明，痰液吉姆萨染色有助于在不进行侵入性检查的情况下快速诊断PLI。
