急性前骨髓細胞白血病：以骨頭之顆粒球性肉瘤呈現且表現出類似骨髓炎症狀的個案報告

Acute Promyelocytic Leukemia: Presentation as Extramedullary Granulocytic Sarcoma, Mimicking Osteomyelitis-Case Report

10.6314/JIMT.2009.20(6).12

林家義(Ka-Ee Ling)；溫武慶(Wu-Ching Uen)

骨頭之顆粒球性肉瘤 ； 急性前骨髓細胞白血病 ； 骨頭掃描 ； Granulocytic sarcoma of bone ； Acute promyelocytic leukemia ； Bone scan

內科學誌

20卷6期（2009 / 12 / 01）

561 - 564

繁體中文

一位25歲女性因爲重度左側臀部疼痛併左腳跛行，疑細菌性骨髓炎安排住院治療。由於其症狀持續惡化，對抗生素治療無效，血液檢查發現輕度貧血外，並無明顯異常。核醫骨頭掃描顯示左後側髂骨上有增強之顯影。病患接受患部的骨髓穿刺及切片檢查確定急性前骨髓細胞白血病的診斷，進而接受成功的治療。此個案說明了初期急性白血病也可能呈現近乎正常的血液像，只出現局部的骨頭疼痛、跛行爲初期表徵，而醫師必須保持警覺於可疑的地方進行必要的檢查。借助核醫骨頭掃描可以將早期急性白血病的病灶處呈現出來，而骨髓穿刺仍是急性白血病最重要的診斷依據。

We describe a unique case of acute promyelocytic leukemia (APML) in a 25-year-old female patient presenting with severe left hip pain and left leg claudication. She was treated as osteomyelitis initially, however her symptoms kept on progressing despite antibiotics treatment. Her hemogram was nearly normal except mild normocytic anemia. Bone scan revealed increased tracer uptake at left posterior iliac bone. Bone marrow aspirate and biopsy confirmed the diagnosis of acute promyelocytic leukemia (M3). She was subsequently treated successfully with standard chemotherapy with cytarabine, anthracycline and all-transretinoid acid and is relapse-free for 5 more years up to the reporting time. This case demonstrates that regional bone pain and claudication may be early presentation of APML with normal hemogram. Bone scan can identify areas of abnormal bone growth or breakdown, physicians should prompt to bone marrow study if a bone marrow disease is suspected.