三尖弁血栓の剥離により肺塞栓をきたした急性骨髄性白血病の1例

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The patient, a 39-year-old man, was admitted on August 23, 1976, because of anemia and general fatigue. Peripheral blood examination revealed leukocytosis of 110, 600/cmm. with 86 per cent of peroxidase positive myeloblasts. A diagnosis of AML was made.<BR>On the 10 th hospital day, he was clinically improved following the treatment with daunorubicin, methotrexate and prednisolone. On the 15 th hospital day, leukocyte count rose to 10, 000/cmm. with 35% myeloblasts and 12% promyelocytes. Platelet count decreased to 30, 000/ cmm.. Coagulation studies revealed marked decrease of fibrinogen (20mg/dl), increase of FDP (50μg/ml), prolongation of prothrombin time (15sec., 45%) and the extraordinary reduction of euglobulin lysis time (30min.) . Those were suggestive of the presence of disseminated intravascular coagulation. He was treated again with DCP without clinical responses. On the 25 th hospital day, he had a sudden onset of chest pain, fever and bloody expectoration. A chest film showed diffuse infiltration in the left lower field. An electrocardiogram disclosed no findings of pulmonary infarction. He was expired on September 17, 1976.<BR>On postmortem examination, pulmonary embolus and thrombus adhering to tricuspid valve were found.<BR>Pulmonary embolus might be originated from the thrombus adhering to tricuspid valve caused by disseminated intravascular coagulation.