1980 Volume 11 Issue 4 Pages 427-433
This 24-years-old patient was delivery at 36 weeks of gestation by cesarian section (normal male infant). Two days after delivery, she was transferred to our hospital complaining of continuous nasal bleeding and fever, (both symptoms being seen for the past 7 days before delivery). Hematologic investigation on admission showed : Hb 8.7g/dl, WBC 16400/cmm (blast cells : 75%, seg : 1%, mono : 4%, lympho : 20%) and Platelets 21000/cmm. The bone marrow was replaced by primitive myeloid cells, the dominant cell type being monocyte. Uric muramidase was remarkably increased. A diagnosis of acute monocytic leukemia was made as result of a bone marrow examination and uric muramidase. Remission induction therapy (DNR, Ara-C. 6-MP, Pred.) and antibiotics therapy (SBPC, GM) were started from the third hospital day. On 7th day of the therapy, operative wound of cesarian section was opened. She developed severe pyrexia associated with infection of cesarian section wound, which eventually broke down. Bacterological examination of cesarian section's pus and blood culture indicated E. coli and Pseudomonus aeruginosa from which septicemia was diagnosed. In spite of intensive supportive therapy, she died 3 weeks later from remission induction therapy. Autopsy findings were follows : 1) Acute monocytic leukemia. 2) Hepatomegaly ; 2480g. 3) Splenomegaly ; 240g. 4) Aspergilosis of the lung, esophagus, stomach and renal pelvis. 5) Rupture of the uterus (at the suture site due to by endometriosis).
