内容紹介
A Case of Acute Lymphoblastic Leukemia with Adult-Onset Still's Disease-Like Erythema
Summary
A 62-year-old woman developed B lymphoblastic leukemia(B-ALL)in April 2010, and achieved complete remission after hyper-CVAD/high-dose-MA therapy combined with rituximab. ALL recurred in December 2011, and remission was again achieved with the Japan Adult Leukemia Study Group(JALSG)ALL202 protocol combined with rituximab. Owing to a fever and rash that persisted from July 2012, the patient was examined again. On examination, redness was observed in the pharynx, and poorly defined oval erythemas were seen on the cheeks, posterior region of the neck, and upper arms. Blood test results showed high levels of ferritin, tumor necrosis factor(TNF)-α, and C-reactive protein(CRP), and mild hepatosplenomegaly was identified on abdominal computed tomography(CT), indicative of an adult-onset Still's disease-like condition. Prednisolone therapy was initiated in August 2012, and remission was achieved. A second recurrence of ALL developed in September 2012, and although remission was again achieved using the JALSG ALL202 protocol, a third recurrence of ALL occurred in April 2013, and the patient could not be saved. In this case, adult-onset Still's disease-like erythema developed during the remission phase of ALL.
要旨
症例は62歳,女性。2010年4月にB細胞性急性リンパ性白血病(B-ALL)を発症し,rituximab併用hyper-CVAD/MA療法により完全寛解となった。2011年12月にALL再発のため,rituximabを併用したJALSG ALL202プロトコールにより再寛解を得た。2012年7月より発熱と皮疹のため再診となり,咽頭発赤と頬部・後頸部・上腕に境界不明瞭な紅斑を認めた。血清フェリチンとtumor necrosis factor(TNF)-α,CRPの高値,腹部CTで軽度肝脾腫を認め,成人Still病様の病態であると判断し,8月より副腎皮質ステロイド療法にて緩解した。9月にALLの第二再発を認め,JALSG ALL202プロトコールにて再寛解したが,2013年4月にALLの第三再発のため永眠された。本症例は,ALLの寛解期に一致して成人Still病様皮疹が顕性化した。
目次
Summary
A 62-year-old woman developed B lymphoblastic leukemia(B-ALL)in April 2010, and achieved complete remission after hyper-CVAD/high-dose-MA therapy combined with rituximab. ALL recurred in December 2011, and remission was again achieved with the Japan Adult Leukemia Study Group(JALSG)ALL202 protocol combined with rituximab. Owing to a fever and rash that persisted from July 2012, the patient was examined again. On examination, redness was observed in the pharynx, and poorly defined oval erythemas were seen on the cheeks, posterior region of the neck, and upper arms. Blood test results showed high levels of ferritin, tumor necrosis factor(TNF)-α, and C-reactive protein(CRP), and mild hepatosplenomegaly was identified on abdominal computed tomography(CT), indicative of an adult-onset Still's disease-like condition. Prednisolone therapy was initiated in August 2012, and remission was achieved. A second recurrence of ALL developed in September 2012, and although remission was again achieved using the JALSG ALL202 protocol, a third recurrence of ALL occurred in April 2013, and the patient could not be saved. In this case, adult-onset Still's disease-like erythema developed during the remission phase of ALL.
要旨
症例は62歳,女性。2010年4月にB細胞性急性リンパ性白血病(B-ALL)を発症し,rituximab併用hyper-CVAD/MA療法により完全寛解となった。2011年12月にALL再発のため,rituximabを併用したJALSG ALL202プロトコールにより再寛解を得た。2012年7月より発熱と皮疹のため再診となり,咽頭発赤と頬部・後頸部・上腕に境界不明瞭な紅斑を認めた。血清フェリチンとtumor necrosis factor(TNF)-α,CRPの高値,腹部CTで軽度肝脾腫を認め,成人Still病様の病態であると判断し,8月より副腎皮質ステロイド療法にて緩解した。9月にALLの第二再発を認め,JALSG ALL202プロトコールにて再寛解したが,2013年4月にALLの第三再発のため永眠された。本症例は,ALLの寛解期に一致して成人Still病様皮疹が顕性化した。