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[Pulmonary infiltration of acute monoblastic leukemia diagnosed by transbronchial lung biopsy]
Naonori Harada1, Takahiko Nakane1, Hiroshi Okamura1
1Hematology, Graduate School of Medicine, Osaka City University.
Insights
A 65-year-old woman with acute monoblastic leukemia experienced lung infiltration. Prompt diagnosis via lung biopsy and intensive chemotherapy led to remission, highlighting the importance of pathological confirmation for effective treatment.
Area of Science:
- Hematology
- Pulmonology
- Oncology
Background:
- Acute myeloid leukemia (AML) can present with pulmonary complications, often mimicking infections or heart failure.
- Distinguishing leukemic lung infiltration from other pulmonary issues in AML patients is clinically challenging.
Observation:
- A 65-year-old female presented with antibiotic-resistant fever, hypoxemia, and hyperleukocytosis, diagnosed with acute monoblastic leukemia.
- Chest CT revealed interlobular septal thickening, ground-glass opacity, and a nodular shadow, initially unresponsive to infectious disease and heart failure treatments.
- Transbronchial lung biopsy confirmed pulmonary leukemic infiltration, prompting intensive chemotherapy.
Findings:
- Intensive chemotherapy resulted in the resolution of abnormal lung shadows on CT scans.
- Complete hematological remission was achieved in the patient.
- Pathological confirmation of pulmonary leukemic infiltration was crucial for successful treatment.
Implications:
- Accurate pathological diagnosis of pulmonary leukemic infiltration is vital for guiding appropriate therapy in AML patients.
- This case underscores the importance of considering leukemic infiltration in AML patients with unexplained pulmonary symptoms.
- Timely and accurate diagnosis leading to targeted chemotherapy can significantly improve patient outcomes in cases of AML-related lung disease.
Abstract:
A 65-year-old woman was urgently admitted to our hospital for antibiotic-resistant fever, hypoxemia, and hyperleukocytosis and was diagnosed with acute monoblastic leukemia. Chest computed tomography revealed interlobular septal thickening, central ground-glass opacity, and a nodular shadow in the left lower lobe. Although several treatments for infectious disease and acute heart failure were administered, they were less effective. Transbronchial lung biopsy was performed on day 7 of hospitalization, and subsequently, pulmonary leukemic infiltration was confirmed. Based on the diagnosis, we decided to start intensive chemotherapy. Consequently, the abnormal lung shadow on computed tomography vanished, and complete hematological remission was achieved. Although acute myeloid leukemia is frequently associated with lung infiltration during onset, it is often difficult to distinguish it from other pulmonary complications. In clinical practice, intensive chemotherapy is often initiated based on the clinical evaluation without pathological confirmation of the lung disease. Our patient was accurately diagnosed based on the pulmonary leukemic infiltration observed pathologically and recovered well. Here we report our case along with a discussion of the relevant literature.
