1984 Volume 25 Issue 5 Pages 679-684
A 36-year-old male was admitted to our hospital on 26th November, 1981. He complained of gingival bleeding, persistent high fever, and severe general fatigue. Hematological findings were as follows; the white blood cell count was 28,200/mm3 with 93% of leukemic cell, and the platelet count was 40,000/mm3. Bone marrow aspiration revealed that the frequency of atypical promyelocytes was 80.4%, and he was diagnosed as acute promyelocytic leukemia. The chromosomal abnormality such as 46, XY, t(8; 17) (p22; q21)/47, XY, +8, t(8; 17) (p22; q21) was disclosed by the direct method. Although he was treated with the combined chemotherapeutic regimen consisted of daunomycin, 6-MP, and prednisolone, the number of leukemic cells did not decrease. Then he was treated with adriamycin, methotrexate, ACNU, and prednisolone. But the therapy was not effective. On 11th December, 1981, the urine volume was 5 liter per day and the specific gravity of urine was decreased to 1.010. Therefore diabetes insipidus was suspected. Leukemic cells were found in cerebro-spinal fluid, and the level of antidiuretic hormone was very low. The pitressin test was positive. All these findings are compatible with the diagnosis of diabetes insipidus complicated by meningeal leukemia. Repeated intrathecal injection of methotrexate was very effective for meningeal leukemia, and diabetes insipidus also improved. On 12th January, 1982, he complicated pneumonia and died on 8th February, 1982. Autopsy of head was not permitted.
