A 47-year old man was admitted to the Ohmori Red-Cross Hospital because of recurrent high fever associated with systemic bone and joint pain on September 25, 1978.
On admission, hematologic examination showed no anemia nor thrombocytopenia and moderate leukocytosis with appearance of immature granulocytes and erythroblasts in a low percentage.
Recurrent bone narrow aspiration was all dry tap. At the beginning of October, pancytopenia developed rapidly with transient remarkable elevation of serum LDH activity up to 26,000 IU/ml, and serum uric acid 27 mg/dl, previous to the initiation of antileukemic chemotherapy.
He died of sepsis on October 18. Autopsy showed diffuse proliferation of promyelocytes in the bone marrow and a diagnosis of acute promyelocytic leukemia was established.
Multiple bone marrow necroses were seen in the vertabrae, costae, sternum and iliac bone. The remarkalde elevation of serum LDH and uric acid in this case is attributed to the necrosis of leukemic cells in the bone marrow.
