Abstract
The patient, 15-year-old boy, was reffered for evaluation of nasal and subcutaneous bleeding in August 1976. Idiopathic thrombocytopenic purpura (I.T.P) was diagnosed by thrombocytopenia, increased immature megakaryocytes in bone marrow and positive antiplatelet antibody. Prednisolone was administered without remarkable benefit.
About 2 years later, he gradually became pancytopenic with slightly increased myeloblasts in bone marrow, but immature cells were not detected in peripheral blood. Late in Octover 1978, acute myelomonocytic leukemia was diagnosed by hematological findings such as remarkably increased leukemic cells with abnormal chromosomal pattern in peripheral blood and bone marrow. Spleen and liver enlarged rapidly without administration of antileukemic agents. Late in February 1979, he died of fungal infection.
Autopsy findings showed bone marrow fibrosis, extramedullary hematopoiesis and leukemic infiltration in spleen and liver. This case was thought that his I.T.P like symptoms at clinical onset might be those of preleukemic stage and myelofibrosis progressed secondarily due to changes of hematopoietic microenvironment in its stage.
