著者

田北 淳 藤永 逸 沢江 義郎 服部 絢一 光安 如成

出版者

一般社団法人 日本血液学会

雑誌

臨床血液 (ISSN:04851439)

巻号頁・発行日

vol.8, no.6, pp.690-698, 1967 (Released:2008-10-20)

参考文献数

33

被引用文献数

3

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A 44 years old house-wife was admitted to the hospital in September, 1964, with complaints of general malaise, tachypnea. fever and hemorrhagic diatheses. Physical examinination revealed severe anemia, but neither hepatolienomegaly nor lymphadenopathy. Blood examination showed hemoglobin, 3.8 g/dl, leukocytes, 16,600 with the following differentials: blast cells 74% promyelocytes 1%, metamyelocytes 3%, neutrophils 12%, monocytes 3%, and lymphocytes 17%, and platelets, 76,000. Sternal marrow study showed hypercellularity (261,000) with a good number of myeloblasts (32%).She was treated with blood transfusios of 3,560 ml for 54 days, dexamethasone of 135 mg for 54 days and 6-mercaptopurin 2,050 mg for 35 days, in total, respectively, with an uneventfull effect, and discharged in November, 1964. Thirty days after the discharge, however, leukocyte counts in the blood raised to 29,400 with dominant myeloblasts (85%). She was readmitted in December, 1964. Blood transfusions, dexamethasone and 6-mercaptopurin were administered with no remarkable effect this time.In March, 1965, she complained of back pain for 7 days, followed by untolerable leg pain in about 7 days and then a complete transverse myelitis at the 3rd tholacic segment suddenly developed which comprised paraplegia of the lower extremities, anesthesia in both the abdomen and lower extremities, and retention of urin. She died on 24 th April 1965, about 30 days after the developement of such neurological complications.Post mortem examination disclosed marked infiltration of myeloblasts throughout the tissue, particularly in the bone marrow, spleen, liver and kidneys. Besides, there was found marked myeloblastic infiltration in the dura mater over the whole length of the spinal cord, resulting in liquefaction necrosis of the spinal cord from the 3rd tholacic segments to the cauda equina.