Okamura Tadashi, Murata Shogo, Miyamoto Kyohei, Tane Misato, Okabe Yuka, Takeda Satomi, Tabata Shotaro, Kosako Hideki, Hori Yoshikazu, Yamashita Yusuke, Mushino Toshiki, Hosoi Hiroki, Sonoki Takashi
Department of Hematology/Oncology, Wakayama Medical University.
Department of Emergency and Critical Care Medicine, Wakayama Medical University.
Rinsho Ketsueki. 2024;65(3):169-174. doi: 10.11406/rinketsu.65.169.
A 44-year-old woman was diagnosed with acute myeloid leukemia (RUNX1::RUNX1T1 translocation) and received induction chemotherapy with idarubicin hydrochloride and cytosine arabinoside. The pneumonia that had been present since admission worsened, and a drug-induced skin rash appeared. On day 17, she presented with respiratory failure and shock, complicated by hemoconcentration and hypoalbuminemia. This was considered capillary leak syndrome due to pneumonia and drug allergy, so she was started on pulse steroid therapy and IVIG, and was intubated on the same day. On day 18, venovenous-extracorporeal membrane oxygenation (VV-ECMO) was started due to worsening blood gas parameters despite ventilatory management. Bronchoalveolar lavage fluid was serous, and both blood and sputum cultures yielded negative. The patient was weaned from VV-ECMO on day 26 as the pneumonia improved with recovery of hematopoiesis. She was disoriented, and a CT scan on day 28 revealed cerebral hemorrhage. Her strength recovered with rehabilitation. After induction chemotherapy, RUNX1::RUNX1T1 mRNA was not detected in bone marrow. The patient received consolidation chemotherapy, and has maintained complete remission. Severe respiratory failure during induction chemotherapy for acute leukemia can be fatal, but VV-ECMO may be lifesaving.
一名44岁女性被诊断为急性髓系白血病（RUNX1::RUNX1T1易位），并接受了盐酸伊达比星和阿糖胞苷的诱导化疗。自入院以来就存在的肺炎病情恶化，且出现了药物性皮疹。在第17天，她出现呼吸衰竭和休克，并伴有血液浓缩和低白蛋白血症。这被认为是由肺炎和药物过敏引起的毛细血管渗漏综合征，因此开始给予脉冲类固醇治疗和静脉注射免疫球蛋白，并于同一天进行了气管插管。在第18天，尽管进行了通气管理，但由于血气参数恶化，开始了静脉-静脉体外膜肺氧合（VV-ECMO）治疗。支气管肺泡灌洗液体为浆液性，血液和痰培养均为阴性。随着肺炎改善和造血功能恢复，患者在第26天脱离了VV-ECMO。她出现了定向障碍，第28天的CT扫描显示有脑出血。经过康复治疗，她的体力恢复。诱导化疗后，骨髓中未检测到RUNX1::RUNX1T1 mRNA。患者接受了巩固化疗，并维持完全缓解状态。急性白血病诱导化疗期间的严重呼吸衰竭可能是致命的，但VV-ECMO可能挽救生命。
