一位66歲女性以肺腫塊表現的白血病髓外肺浸潤案例

白血病髓外肺浸潤是一種罕見的臨床疾病，因其胸部X光和臨床表徵不具特異性，診斷困難往往延誤適當的治療。本案例為66歲女性，因發燒、咳嗽、活動後呼吸急促就醫，胸部電腦斷層顯示疑似肺膿瘍。因初步診斷為肺膿瘍故行豬尾巴導管置放術併切片檢查，病理報告僅顯示慢性發炎，且以多線抗生素藥物治療。爾後因周邊血液出現芽細胞，經骨髓切片診斷為急性骨髓性白血病，隨著病人發燒未改善，醫療團隊針對肺膿瘍，安排胸腔鏡行右上葉切除、右下葉楔狀切除及肺剝離術，最終肺組織病理報告確診為急性骨髓性白血病併髓外肺浸潤。經此案例予臨床重要省思是當病人反覆發燒且電腦斷層影像疑似肺膿瘍生成，抗生素藥物治療效果不彰，必須將白血病併髓外肺浸潤列入鑑別診斷，且一經確診為白血病髓外肺浸潤，應及早針對白血病疾病治療，以免誤判病人肺部有感染情形，而延後癌症治療，增加病人死亡風險。

關鍵字

肺膿瘍；急性骨髓性白血病；髓外白血病

並列摘要

Acute myeloid leukemia with extramedullary pulmonary infiltration is a rare clinical case. Without specific clinical manifestations and imaging features, the diagnosis is often challenging, leading to a delay in treatment. The case is of a 66-year-old female patient, who visited the emergency department due to cough, fever and exertional dyspnea. Due to recurrent fever, a chest CT scan was performed and revealed lung abscess. Based on the initial diagnosis of lung abscess, pigtail catheter placement and bronchial biopsy were performed. The pathological report showed only chronic inflammation. Thus, the patient was treated with multiple antibiotics and antifungals. Due to the detection of blast cells in the peripheral blood via the complete blood count, bone marrow biopsy was performed and then acute myeloid leukemia was confirmed. However, the recurrent fever continued for one month. The medical team arranged thoracoscopy for right upper lobe resection, right lower lobe wedge resection, and lung pneumonolysis for the lung abscess. Pulmonary histopathological report eventually confirmed acute myeloid leukemia with extramedullary pulmonary infiltration. This case suggested that when a patient has recurrent fever and the CT image shows suspected lung abscess formation, antibiotic treatment may not be effective. Extramedullary infiltration of leukemia should be suspected in the differential diagnosis. Once confirmed as extramedullary pulmonary infiltration of leukemia, leukemia related treatment should be provided as soon as possible. The delay of cancer treatment, which may increase the risk of mortality.

並列關鍵字

Lung abscess ； acute myeloid leukemia ； extramedullary leukemia

參考文獻

王怡凱、謝麗鳳（2019）．急性骨髓性白血病用藥新擇—Venetoclax．腫瘤護理雜誌，19（1），5－11。https://doi.org/10.6880/TJON.201906_19(1).01

徐慧中、陳宥任（2014）．益氣養陰法輔助治療白血病化療後發熱的研究．臺灣中醫科學雜誌，7（2），1－24。https://doi.org/10.29810/SJTTCM.201402_7(2).0001

陳秋如、項怡平、王郁青、李炳鈺、王銘崇（2014）．使用Azacitidine治療骨髓化生不良症候群之高危險病患之探討．臺灣臨床藥學雜誌，22（3），175－182。https://doi.org/10.6168/FJCP.2014.2203.06

隋宜珊、尹慧琤、譚美珠、巫宜楹、陳維志、劉學致（2017）．獨立肺通氣模式應用於單側肺膿瘍之呼吸照護經驗．呼吸治療雜誌，16（2），13－25。https://doi.org/10.6269/JRT.2017.16.2.02

黃家榆、林志學、王牧羣（2019）．老年人肺部膿瘍的非典型表現：病例報告．台灣老年醫學暨老年學會雜誌，14（3），169－ 179。https://doi.org/10.29461/TGGa.201908_14(3).0004

主題瀏覽