1 / 17

بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. Case Presentation. Patient’s History. A. Y. female patient 4 years old is living in Cairo Presented outside NCI by Persistent fever Pallor Outside NCI CBC: 55% blasts. Clinically. Fair general condition Pallor Symptoms of increased ICT

emily
Download Presentation

بسم الله الرحمن الرحيم

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. بسم الله الرحمن الرحيم

  2. Case Presentation

  3. Patient’s History • A. Y. female patient 4 years old is living in Cairo • Presented outside NCI by • Persistent fever • Pallor • Outside NCI CBC: 55% blasts

  4. Clinically • Fair general condition • Pallor • Symptoms of increased ICT • No other neurological deficit • No organomegaly or lymphadinopathy • Chest, heart, & abdominal examination: free

  5. Investigations • CBC: TLC 7500, ANC 500, Hb 6, Plt 65000 • BM aspiration: AML M3 • IPT: myeloid CD 33, 13 MPO +ve • Cytogenetics: 46 XX t 15-17 • CSF: ++ve • Brain MRI: normal • Chest x-ray & abdominal US: free

  6. Treatment • Induction: • ADR 45 mg/ m2 (d 1, 2, & 3) • ATRA 45 mg/ m2 till remission • Intra thecal weekly • Consolidation: • 2 courses of ADR 45 mg/ m2 (d 1, 2, & 3)

  7. She was planned to receive craniospinal radiotherapy • & to be put on maintenance chemotherapy • MTX 20 mg /m2 weekly • 6 MP 75 mg / m2 • ATRA 45 mg /m2 for 2 weeks every 12 weeks • Radiotherapy was postponed due to poor chest condition

  8. Chest condition • Fever • Respiratory distress Gr III • Neutropenia • Chest x-ray: pleural effusion Chest Infection ATRA Syndrome Malignant effusion Plural effusion cytology: -ve Stopped chemotherapy

  9. Chest Infection • Broad spectrum antibiotic • Follow up chest x-ray: • encysted pleural effusion • CT chest: • pleural based mass with central • breaking down • Sputum C&S: • Many cndidal colonies • Amphotercin B was added Re evaluation after 2 weeks • Follow up chest CT: • no appreciable changes • Another sputum C&S: • gram +ve cocci only sensitive to vancomycin • Vancomycin was added for 2 weeks • Follow up chest CT: • marked improvement

  10. After improvement of the chest condition, the patient received • Craniospinal irradiation • Continued maintenance chemotherapy

  11. Seven months later, the patient had • Hematological relapse • CBC: TLC 16000, Hb 9.6, Plt 26000, blasts 57% • BM aspirate: • AML M3 in relapse • 20% blasts • CNS manifestation

  12. CNS disease • Fever & headache • Convulsions • Aphasia • Blurring of vision • Neck stiffness • Behavioral changes • Leukemic infiltration • Suspected due to • Previous history of CNS infiltration • hematological relapse • CNS Infection • Suspected due to: • Fever & • neck stiffness Empirical ttt by Brain dehydrating measures • Salvage chemotherapy • Intra thecal injections • Anti bacterial • Acyclovir &

  13. Results of Investigation Empirical treatment was continued until the collection of data from • Radiological investigations: MRI revealed: Lt tempro-parieto-occipital infiltration with lepto-meningeal distribution & gyral edema

  14. Laboratory investigation • CSF analysis: • High TLC • High protein content • Normal sugar & Chloride content • CSF C & S: • +ve for HSV type I by monoclonal antibodies • -ve for bacterial & fungal growth

  15. Revaluation by BM aspirate revealed Complete Remission CNS condition markedly improved

  16. Plan of future treatment RT PCR for t 15-17 +ve -ve Allogenic BMT Auto BMT

  17. Thank You

More Related