Acute monocytic leukemia presenting as acute respiratory failure
Acute monocytic leukemia presenting as acute respiratory failure
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DOI：
10.1164/rccm.200206-554oc
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发表时间：
2003-05-15
影响因子：
24.7
通讯作者：
Schlemmer, B
中科院分区：
文献类型：
--
作者：
Azoulay, É;Fieux, F;Schlemmer, B
急性呼吸衰竭表现为急性单核细胞白血病是罕见的。我们报告了20例重症监护病房（ICU）的患者，他们有三个显著特征：（1）急性白血病的快速进展性呼吸窘迫，（2）单核细胞白血病，（3）化疗开始后呼吸状态恶化。中位年龄为50岁（117-72岁），呼吸道症状在入住ICU前2天（0-15天）开始。白细胞计数中位数为98，250/mm 3（800- 529，000），除1名患者外，所有患者均存在循环单核细胞。所有患者的骨髓检查均诊断为单核细胞白血病。就诊时，呼吸频率为33（18-50）/min，室内空气中的PaO 2为44.5 mmHg（30-60）。胸片显示单侧肺泡浸润（n = 1），双侧肺泡浸润（n = 3）或不伴胸腔积液（n = 11），或弥漫性间质浸润（n = 5）。肺泡出血是主要的支气管肺泡灌洗结果，单核细胞从4例患者中回收。所有患者在癌症化疗开始后呼吸功能均恶化。在15名需要机械通气的患者中，10名死亡。白血病肺浸润作为急性单核细胞白血病的第一个表现应该被认识到，并应提供强化管理，预计呼吸功能恶化后，化疗开始一致。
Acute respiratory failure revealing acute monocytic leukemia is rare. We report 20 patients admitted to the intensive care unit (ICU) with three remarkable features: (1) rapidly progressive respiratory distress revealing acute leukemia, (2) monocytic leukemia, and (3) respiratory status deterioration after chemotherapy initiation. The median age was 50 years (117-72 years), and respiratory symptoms started 2 days (0-15 days) before ICU admission. The median leukocyte count was 98,250/mm(3) (800-529,000), with circulating monocytic cells in all of the patients but one. Bone marrow examination was diagnostic of monocytic leukemia in all patients. At presentation, respiratory rate was 33 (18-50) per minute, and PaO2 on room air was 44.5 mm Hg (30-60). Chest radiographs revealed unilateral alveolar infiltrates (n = 1), bilateral alveolar infiltrates with (n = 3) or without (n = 11) pleural effusion, or diffuse interstitial infiltrates (n = 5). Alveolar hemorrhage was the main bronchoalveolar lavage finding, with monocytic cells retrieved from four patients. Respiratory function deteriorated after cancer chemotherapy initiation in all patients. Of the 15 patients who required mechanical ventilation, 10 died. Leukemic pulmonary infiltration as the first manifestation of acute monocytic leukemia should be recognized, and intensive management should be provided in anticipation of the respiratory function deterioration seen consistently after chemotherapy initiation.