Schenkein D P, O'Neill W C, Shapiro J, Miller K B
Ann Intern Med. 1986 Sep;105(3):375-8. doi: 10.7326/0003-4819-105-3-375.
A patient with acute monocytic leukemia and fibrosis presented with severe hypocalcemia producing tetany, myocardial failure, and ventricular tachycardia with torsades de pointes configuration. Hypophosphatemia, hypomagnesemia, an elevated alkaline phosphatase level, and osteosclerosis were also present. Bone marrow biopsy samples showed fibrosis and thickened bony trabeculae lined with large osteoblasts. Tetracycline labeling showed an increased rate of calcification. Complete remission of the leukemia and fibrosis was achieved with a single 3-week course of low-dose cytarabine and hydroxyurea, with resolution of the hypocalcemia and hypophosphatemia. Calcitriol and etidronate disodium were also administered. The calculated left ventricular ejection fraction increased from 15% to 55% with correction of the hypocalcemia. The hypocalcemia and hypophosphatemia in this patient probably resulted from accelerated bone formation stimulated by the leukemic cells. The high dose of calcitriol that this patient received may have contributed to the remission of the leukemia.
一名患有急性单核细胞白血病并伴有纤维化的患者出现严重低钙血症，导致手足搐搦、心肌衰竭以及尖端扭转型室性心动过速。同时还存在低磷血症、低镁血症、碱性磷酸酶水平升高以及骨硬化。骨髓活检样本显示有纤维化以及由大型成骨细胞排列的增厚骨小梁。四环素标记显示钙化速率增加。通过为期3周的单一疗程低剂量阿糖胞苷和羟基脲治疗，白血病和纤维化实现完全缓解，低钙血症和低磷血症也得以缓解。同时还给予了骨化三醇和依替膦酸二钠。随着低钙血症的纠正，计算得出的左心室射血分数从15%升至55%。该患者的低钙血症和低磷血症可能是由白血病细胞刺激导致的骨形成加速所致。该患者接受的高剂量骨化三醇可能有助于白血病的缓解。
