A 31-year-old woman was admitted to our hospital following 2 weeks of nausea, vomiting, polydipsia, and polyuria. She had been well until 3 months previously, when anemia was pointed out on an annual examination. Iron was prescribed to no effect.
On admission, she was pale but appeared well. There was no lymphadenopathy, hepatosplenomegaly, or petechiae. Daily urine output ranged from 3 to 5
l. The urine was unremarkable except for low specific gravity. Initial hemoglobin level was 7.8g/d
l. White blood cell (WBC) count was 2,300/mm
3 with 8% myeloblasts, 4/100 WBC erythroblasts, 9/100 WBC megakaryocytes. Platelet count was 790×10
3/mm
3. Bone marrow examination showed proliferation of myeloblasts and erythroblasts with PAS-positive megaloblastoid features. A diagnosis of erythroleukemia was made.
After 2 courses of DCMP (Daunomycin, Behenoyl Ara-C, 6MP, Prednisolone) therapy, urine output temporarily decreased to around 2
l, but increased again 3 months later, ranging from 4 to 7
l. Water deprivation test and Carter-Robbins test established the diagnosis of central diabetes insipidus. Neurological examination was unrevealing. DDAVP was given with unsatisfactory response. Although therapeutic irradiation of 4000 rad to the pituitary area showed no immediate effect, her diabetes insipidus was relatively mild several weeks later.
Despite chemotherapy including DCMP, aclacinomycin-A, and VP (Vindesine, Prednisolone), hematological remission was not attained. However, her general conditionremained well and as of end of July, 1981, she is being fairly controlled at the out-patient clinic, with small doses of corticosteroid and blood transfusion.
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