A 52-year-old male has been well until seven months previously, when he began to complain of petechiae. He was admitted to Kitami Red Cross Hospital for examinations of bleeding tendency on November 5, 1979. Physical examinations on admission showed no abnormalities except for petechiae. His peripheral blood count was as follows: RBC 451×104/mm3, WBC 5,600/mm3 (neutrophils 46, monocytes 10, lymphocytes 44%), platelets 8.3×104/mm3. Nucleated cell count of bone marrow was 8.8×104/mm3 and megakaryocytes were 30/mm3. The results for examinations of coagulation and fibrinolysis were normal except for prolonged bleeding time. Tentatively the diagnosis of idiopathic thrombocytopenic purpura (ITP) was made.
He was discharged from the hospital on November 27, 1979. Since then he was continued to be observed at the out-patient department without any specific treatment for eight months. He was readmitted to the hospital because of eruptions of the skin on lower extremities on June 23, 1980. The physical examinations on admission showed petechiae and erythema nodosum. His peripheral blood count was as follows: RBC 373×104/mm3, WBC 7,700/mm3 (neutrophils 25, monocytes 3, lymphocytes 66, blasts 6%), platelets 10.5×104/mm3. Bone marrow was hypocellular with normal number of megakaryocytes. Blasts in the bone marrow were 11.9%. Acute monocytic leukemia (M 5) was diagnosed on the basis of cytological and histochemical findings.
Despite the treatments in combination with daunorubicin, cytocine arabinocyde, 6-mercaptpurine and prednisolone (DCMP), remission was not obtained. On the sixty-fourth hospital day he died of pulmonary bleeding due to disseminated intravascular coagulation syndrome, which was confirmed by an autopsy.
