Abstract
A case of erythroleukemia with erythocytosis was described. A 56-year-old male was admitted with a chief complaint of pain on the chest, flank and back. Family and past history was non-contributory. Physical examination revealed multiple lymphadenopathy in cervical and axillar regions, moist rales over both bases of lung, and hepatosplenomegaly. His peripheral blood and bone marrow examinations disclosed a diagnosis of erythroleukemia. CBC showed marked erythrocytosis (RBC 6,030,000, Hb 18.1 Gm/100ml, Ht 57,5%), leukocytosis of 32,100/cmm and thrombocytopenia (28,000/cmm) with 56% of leukemic cells. An aspirate of sternal marrow showed hypercellularity with megaloblastoid change and marked atypism of nucleus in these erythroblasts which had negative peroxidase and positive PAS staining. Index of neutrophil alkaline phosphatase staining was 92% and score was 299. Whole blood viscosity was 8.4 cp. Chest X-rays showed enlarged silhouette and infiltrative shadow in both lower lung fields. Computed tomography of brain revealed scattered multiple low density areas. He poorly responded to the treatment with Ara-C and DNR and developed meningeal leukemia and expired on July 12, 1979.
Autopsy findings revealed multiple infarction in the brain and pancreas. The direct cause of death was concluded to be disseminated candida infections.
It is difficult to conclude that this case of erythroleukemia is on the stage of transformation from polycythemia vera and it might be better to diagnose as erythroleukemia with coexistence of erythrocytosis due to erythroid overproliferation on the stem cell level.
