A 25-year-old man was admitted to the Nihon University Hospital complaining of high fever, general fatigue and leukocytosis on June 26, 1980. Before this admission, he was doubted to have Behçet disease for multiple ulceration of the oral mucosal membrane and on the scrotum. Peripheral blood on admission showed that the WBC count was 24,000/μl with 1.5% of blast cells, 41.5% of myelocyte, 5.0% of metamyelocyte and 4.5% of basophile. The nucleated cell count in the bone marrow was 346,000/μl with 17% of myeloblast, 25.4% of promyelocyte, 25.2% of myelocyte, 12.8% of eosinophile and 3.0% of basophile. Those blasts were positive for peroxydase and PAS stain. NAP rate and score were normal. The serum level of vitamine B12 was 3,200 pg/ml. He had no hepatosplenomegaly on admission. Cytogenetic analysis of the bone marrow cells showed a karyotype of 50, XY, +8, +16, +22q-, t (9q+; 22q-) +mar in 92% of mitoses (double Ph1 chromosome positve). The case was difficult to distinguish blastic crisis of CML from AML (M2). A complete remission could be achieved with BH-AC·DMP therapy. On cytogenetic analysis of the bone marrow in complete remission, the Ph1 positive cells were disappeared. Therefore, the case was retrospectively diagnosed to be Ph1-positive AML.
He was readmitted because of relapse of AML seven months later, when he developed ulceration on the oral mucosal membrane and the scrotum without peripheral basophilia. Cytogenetic analysis of the bone marrow cells at this time showed the same karyotype as the first admission in 72% of mitoses. A complete remission could be achieved again with BH-AC.AMP therapy. At present, he has been in a complete remission.
