Okubo C, Kanamori H, Sasaki S, Taguchi J, Otsuka M, Harano H, Ogawa K, Matsuzaki M, Mohri H, Okubo T
First Department of Internal Medicine, Yokohama City University School of Medicine.
Rinsho Ketsueki. 1997 Jun;38(6):539-43.
A 51 year-old male admitted with petechiae and headache. Acute promyelocytic leukemia (APL) with disseminated intravascular coagulation (DIC) was diagnosed. He received all-trans retinoic acid (ATRA) with enocitabine and daunomycin for induction chemotherapy, and supportive therapy for DIC. On 2nd day after admission, subacute subdural hematoma was confirmed with CT scan. He had anisocoria and disturbance of consciousness, and was treated with neurosurgical operation for his life saving on the 3rd day. Although DIC was continued at this time, the operation was done without problem. The recurrence of hematoma has not occurred after the operation. Furthermore, the findings of DIC disappeared by the day 6 following induction therapy. He achieved a complete remission including cytogenetic findings on 35th day after administration of ATRA and received 3 times of combination chemotherapy as consolidation therapy. It may be difficult to do neurosurgical treatment in the setting of DIC. However, we should consider whether the indications for surgery operation according to the condition of each patient.
一名51岁男性因瘀点和头痛入院。诊断为急性早幼粒细胞白血病（APL）伴弥散性血管内凝血（DIC）。他接受了全反式维甲酸（ATRA）联合恩西他滨和柔红霉素进行诱导化疗，并接受了DIC的支持治疗。入院后第2天，CT扫描确诊为亚急性硬膜下血肿。他有瞳孔不等大和意识障碍，并在第3天接受了神经外科手术以挽救生命。尽管此时DIC仍在持续，但手术顺利完成。术后血肿未复发。此外，诱导治疗后第6天DIC的表现消失。在给予ATRA后第35天，他实现了包括细胞遗传学结果在内的完全缓解，并接受了3次联合化疗作为巩固治疗。在DIC的情况下进行神经外科治疗可能很困难。然而，我们应该根据每个患者的情况考虑手术指征。
