Typhlitis as the Initial Presentation of Acute Lymphocytic Leukemia-A Case Report

我們報告一個以typhlitis（嗜中性白血球缺乏性腸炎）為成人急性淋巴球白血病的最初臨床表現之個案。這位四十五歲男性表現發燒、右下腹痛及腹瀉。在住院時其周邊血液分析發現67%之芽細胞。細胞化學分析確認急性淋巴球白血病之診斷。在住院三天後他的絕對嗜中性白血球數掉至117。腹部電腦斷層掃描發現右邊結腸壁腫脹變厚並有腸週脂肪層之浸潤。糞便分析有潛血反應並可看見梨形鞭毛蟲(Giardia lamblia)。在考慮此個案為急性淋巴球白血病併發typhlitis後，能涵蓋葛蘭氏陰性桿菌、厭養菌以及梨形鞭毛蟲之經驗性抗生素治療立即開始。Typhlitis症狀改善並進行影像學追蹤發現右結腸疾病之緩解。標準急性淋巴球白血病化學治療開始進行，但不幸地病患在發生肺炎時突然發生心室顫動而往生。我們認為typhlitis可以成為急性淋巴球白血病之起始表現，且梨形鞭毛蟲在其致病機轉上可能扮演重要角色。

關鍵字

typhlitis ；嗜中性白血球缺乏性陽炎；梨形鞭毛蟲；急性淋巴球白血病

並列摘要

We report a case of typhlitis as the initial presentation of adult acute lymphocytic leukemia (ALL). A forty-five year old man presented with fever, right lower quadrant pain and diarrhea. On admission the hemogram revealed 67% blast cells in the peripheral blood. A cytochemical study confirmed a diagnosis of ALL. The absolute neutrophil count dropped to 117 three days later. Abdominal computerized tomography showed that the colon was swollen on the right side with an abnormally thickened wall and infiltrations in the pericolic fat. Stool analysis was positive for occult blood and Giardia lamblia. Typhlitis complicating ALL was considered and empirical antibiotics (ceftazidime and metronidazole) which covered Gram negative bacilli, anaerobic bacteria and Giardia lamblia were instituted. The typhilitis symptoms improved and a follow-up abdominal MRI study showed complete resolution of right side colon disease. Standard chemotherapy for ALL (vincristine, daunorubicin, L-asparaginase, prednisolone and intrathecal methotrexate) was given. Unfortunately the patient died after a sudden onset of ventricular fibrillation during an episode of pneumonia. We suggest that typhlitis may present as an initial manifestation of ALL and Giardia lamblia may play a role in its pathogenesis.

並列關鍵字

typhlitis ； neutropenic enterocolitis ； Giardia lamblia ； acute lymphocytic leukemia

國際替代計量

Typhlitis as the Initial Presentation of Acute Lymphocytic Leukemia-A Case Report

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