Abstract
A-68-year-old man was admitted to the Nagoya University Hospital on February 12, 1980, for the evaluation of fever, easy fatigability and leukocytosis. On admission physical examination revealed slight fever, splenomegaly of 1.5 finger breadths below the costal margin, swelling of the right inguinal lymphnode and skin rashes on both legs. His peripheral blood showed hemoglobin of 7.0 g/dl, reticulocytes of 5.8%, platelets of 17.0×104/cmm and white blood cells of 102,000/cmm with 23% monocytes and 67% neutrophils. Most of these monocytes showed an irregular nuclear shape and extremely weak peroxidase reaction. NAP score was 172 (control 292). A bone marrow smear showed hyperplasia of granulo-monocytic series with 5% myeloblasts. Five percent out of whole leukocytes were positive for the double staining of specific and non-specific esterase activity. Ph1 chromosome in marrow cells was negative. Bone marrow culture for CFU-C showed the colony formation of 159/2×105 mononuclear cells (control 100±10). Some of the blood chemistry data were as follows; serum LDH 916U, serum uric acid 9.8 mg/dl, serum iron 98 mcg/dl, serum ferritin 360 ng/ml, serum lysozyme 239 mcg/ml, serum β2-microglobulin 10.01 mg/l, serum V. B12 3,200 pg/ml. CRP was negative and ESR was 7 mm in the first hour.
A diagnosis of chronic myelomonocytic leukemia was made and the patient was followed without specific therapy. It is great interest that there were 3 cases of leukemia in this family including the present patient. This is the 7th family in Japan that has more than 2 cases of leukemia in one pedigree. During incidental urinary infection, white blood cell count elevated up to 255,000/cmm, but gradually returned by the treatment with cephalexin. Except for this complication, the patient did well until March 20, 1980, when he died unexpectedly due to an accident.
