[Acute leukemia complicated by hyperbilirubinemia due to high dose cytosine arabinoside therapy]

A 58-year-old man was admitted to our hospital because of low grade fever and purpura in September. 1987. On admission, his bone marrow aspiration showed nucleated cell count of 48 x 10(4)/mm3 with 94.6% of promyelocyte-like leukemic cells. A diagnosis of acute promyelocytic leukemia was made and he was treated with high dose cytosine arabinoside (HDAra C). After this therapy, serum bilirubin, especially direct bilirubin was increased and hyperbilirubinemia was progressed with normal transaminase levels. He had complicated by pneumonia and died of respiratory failure. Autopsy revealed only cholestasis in the liver with neither hepatic cell necrosis nor cell infiltration. This case was though to be a rare case with cholestatic liver injury due to HDAra C.