패혈증 환자에서 전골수구성 백혈병양 반응을 나타낸 1예
Promyelocytic Leukemoid Reaction: Unusual Findings in a Patient with Sepsis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
호중구성 백혈병양 반응은 용혈, 악성종양, 감염, 독극물 노출 등에서 나타날 수 있다. 일반적으로 만성골수성백혈병과 형태학적으로 유사한데, 전골수구는 특별히 증가하지 않는다. 저자는 전골수구성 백혈병양 반응을 나타내었던 패혈증 환자를 경험하여 보고하는 바이다. 28 세 남자가 신장결석을 제거하기 위해 입원하였다. 경피신장절개결석제거술 시행 후 발열 (체온 37.8 ° C) 과 빈맥 (맥박수 130/min) 소견이 관찰되었고, 급성 신부전, 양측성 흉막삼출 및 폐부종이 발생하였다. 일반혈액검사에서 백혈구 73.39 × 10 9 /L( 전골수구 82%), 혈색소 8.9 g/dL, 혈소판 85 × 10 9 /L 였고 골수검사에서 전골수구가 73.8% 였다. 골수검사 이후 바로 all-trans retinoic acid(ATRA) 치료를 시작하였다. 그 후, 역전사중합효소연쇄반응 검사에서 PML-RARA와 기타 RARA 재배열은 음성이었고, 염색체 검사에서 정상핵형을 확인한 후 ATRA 치료를 중단하였다.
Abstract
Neutrophilic leukemoid reaction may occur in many situations, including hemolysis, malignancy, infection, and exposure to certain toxins. It usually shows morphological overlap with chronic myeloid leukemia in which promyelocytes are not majorly associated. Here, we present a case of promyelocytic leukemoid reaction in a patient with sepsis. A 28-year-old man was admitted for renal stone removal. After percutaneous nephrolithotomy, his condition deteriorated with fever (37.8℃), tachycardia (130/min), acute renal failure, pleural effusion, and pulmonary edema. Complete blood count indicated a white blood cell count of 73.39×109/L including 82% promyelocytes, hemoglobin 8.9 g/dL, and platelet count of 85×109/L. A bone marrow aspirate showed that promyelocytes accounted for 73.8% of all nucleated cells. Following bone marrow examination, treatment with all-trans retinoic acid (ATRA) was started immediately. Reverse transcription polymerase chain reaction (RT-PCR) study revealed the absence of PML-RARA (promyelocytic leukemia-retinoic acid receptor alpha) and other RARA (retinoic acid receptor alpha) rearrangements. Once the chromosome analysis of bone marrow cells demonstrated the normal karyotype, ATRA was discontinued.
참고문헌 (13)
- George TI, "Malignant or benign leukocytosis", Hematology Am Soc Hematol Educ Program, 2012, pp.475~484 (2012)
- Ahmed MA, "Promyelocytic leukaemoid reaction : an atypical presentation of mycobacterial infection", Acta Haematol, 85, pp.143~145 (1991)
- Sanal SM, "Pseudoleukemia: when “leukemia” is not leukemia", Postgrad Med, 65, pp.143~145 (1979)
- Singh ZN, "Leukemoid reaction simulating acute promyelocytic leukemia", J Assoc Physicians India, 47, pp.1031~1032 (1999)
- Grimwade D, "Characterization of acute promyelocytic leukemia cases lacking the classic t(15;17): results of the European Working Party. Groupe Français de Cytogénétique Hématologique, Groupe de Français d’Hematologie Cellulaire, UK Cancer Cytogenetics Group and BIOMED 1 European Community-Concerted Action “Molecular Cytogenetic Diagnosis in Haematological Malignancies”", Blood, 96, pp.1297~1308 (2000)
- Welch JS, "Use of whole-genome sequencing to diagnose a cryptic fusion oncogene", JAMA, 305, pp.1577~1584 (2011)
- Abedin S, "Acute promyelocytic leukemia : preventing early complications and late toxicities", Hematology Am Soc Hematol Educ Program, 2016(1), pp.10~15 (2016)
- Applegate CC, "Role of retinoids in the prevention and treatment of colorectal cancer", World J Gastrointest Oncol, 7, pp.184~203 (2015)
- Tavakolpour S, "The dual nature of retinoic acid in pemphigus and its therapeutic potential: Special focus on all-trans Retinoic Acid", Int Immunopharmacol, 36, pp.180~186 (2016)
- Miziołek B, "The safety of isotretinoin in patients with lupus nephritis : a comprehensive review", Cutan Ocul Toxicol, 36, pp.77~84 (2017)
- Chen S, "Effect of all-trans-retinoic acid on enterovirus 71 infection in vitro", Br J Nutr, 111, pp.1586~1593 (2014)
- Coleman MM, "All-trans retinoic acid augments autophagy during intracellular bacterial infection", Am J Respir Cell Mol Biol, 59, pp.548~556 (2018)
- Lei GS, "All-trans retinoic acid in combination with primaquine clears pneumocystis infection", PLoS One, 8, pp.e53479~ (2013)