Acute myeloid leukemia with TLS-ERG complicating with Sweet syndrome:one case report and literature review
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摘要: 目的:提高对急性髓系白血病(AML)并发Sweet综合征的认识,初步探讨Sweet综合征与结核变态反应综合征的内在联系。 方法:报告1例原发耐药的TLS-ERG阳性AML患者先后出现Sweet综合征和结核变态反应综合征的临床演变过程、相关实验室检查和相关诊疗经过。结果:患者化疗后出现反复高热和颜面部的痛性皮疹。皮疹初发为假性水疱样,后呈红色或紫红色丘疹或结节,经系统抗感染治疗无效。皮肤活检病理提示真皮层嗜中性粒细胞炎性浸润,诊断为Sweet综合征。给予糖皮质激素治疗短暂有效,因病情反复,并出现全身多发大关节疼痛和多发性红斑,考虑结核变态反应综合征,给予抗结核和糖皮质激素联合治疗,高热、皮疹和多发关节疼痛均缓解。结论:Sweet综合征的肿瘤相关型与血液病密切相关,其中最常见的为AML和骨髓增生异常综合征,需要与皮肤浸润、感染相鉴别。本例Sweet综合征糖皮质激素治疗仅短暂有效,因出现结核相关证据,加用抗结核治疗后Sweet综合征完全缓解,因此Sweet综合征也可能为结核变态反应综合征的一部分。Abstract: Objective:To improve understanding about the pathogenesis of acute myeloid leukemia(AML) complicating with Sweet syndrome,and explore the internal relationship between Sweet syndrome and tuberculosis allergy syndrome. Method:A patient who was diagnosed AML with fusion gene TLS-ERG positive expression developed Sweet syndrome and tuberculosis allergy syndrome in sequence.Related laboratory analysis and treatment process of this patient were reported.Result:The patient was refractory to chemotherapy.Moreover,after one cycle of chemotherapy,persistence high fever occurred following by painful skin lesion in the facial surface.Antibiotic drugs could not resolve these symptoms and physical signs.Skin biopsy showed dermic infiltration with diffuse neutrophil cells which was consistent with Sweet syndrome.Thus a short course of corticosteroids was administrated before high fever recurrence.The diagnosis of tuberculosis allergy syndrome was made because multiple arthralgia and erythema nodosum developed.Not only temperature became normal but also rash disappeared after antituberculosis drugs and glucocorticoid were given to the patient.Conclusion: Sweet syndrome can happen in malignant hematology disease especially in AML and myelodysplastic syndrome.It is important to distinguish it from skin leukemia and infections.The leukemia cells and tuberculosis may also contribute to the etiology of Sweet syndrome in this case.
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Key words:
- leukemia,myeloid,acute /
- Sweet syndrome /
- tuberculosis allergy syndrome
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