Phenylbutazone-induced myelodysplastic syndrome with Philadelphia translocation

We present a case of a 69-year-old white male with a 3-year history of a myelodysplastic syndrome probably induced by phenylbutazone, and which developed into an overt leukemic phase. Chromosome analysis in the leukemic phase revealed the bone marrow cells to contain a Philadelphia translocation [46,XY,t(9;22)(q34;q11)]. We discuss the possible association between a prior history of exposure to hemotoxins and myelodysplastic syndromes, and the rarity of a Ph translocation in drug-induced hematologic malignancy.