银屑病合并急性髓细胞白血病一例的治疗观察

Psoriasis Associated with Acute Myelogenous Leukemia and Treatment with Allogeneic Bone Marrow Transplantation:A Case Report

目的报告继发急性髓细胞白血病(M4EO型)的慢性斑块状银屑病1例临床研究及骨髓移植治疗。方法采用临床资料收集,组织病理检查,骨髓和外周血涂片检查,利用流式细胞仪进行细胞免疫分型,用骨髓细胞体外培养做染色体检查及G显带分析。结果患者女,33岁,有寻常性银屑病史20余年,反复出现红斑鳞屑,皮损以斑块为主,有家族史,用多种方法治疗(以中药为主)。近来不明原因肌肉酸痛,牙龈出血,发热伴胸骨叩痛。骨髓检查发现异常幼稚单核细胞及早幼粒细胞,并见含有粗大嗜碱颗粒的嗜酸粒细胞,确诊为急性髓细胞白血病M4EO型,经骨髓细胞免疫分型检查符合诊断。骨髓细胞体外培养做染色体检查,+G-显带发现inv(16)的克隆异常和+8克隆异常,染色体核型为46,XX,inv(16)/47,XX,inv(16),+8(2/22)。经异基因骨髓移植治疗,银屑病皮损完全消退,急性髓性白血病症状缓解,骨髓异常幼稚细胞减少,病情得到有效控制。结论为国内首例寻常性银屑病(斑块状)

Objective To report a case of psoriasis vulgaris associated with acute myelogenous leukemia(AML)(type M4EO).Methods Clinical data from the patient were collected.Histopathologic examination,and examination of bone marrow and peripheral blood smear were performed.The immunologic types of bone marrow cells were analyzed with FACS.Chromosome and G-banding analyses were carried out with cultured bone marrow cells.Results A33-year-old woman had a history of chronic plaque psoriasis for20years.Her cousin had the same disease history.The patient was treated with various therapeutic regi-mens,most of which were traditional Chinese medicines.Recently the patient suffered from myalgia and chest bone pain,periodic bleeding on gums,fever and so on.The abnormal infantile monocytes and promye-locytes were found with bone marrow smear,and crassitude basophilic granules were noticed in eosinophils.The diagnosis of acute myelogenous leukemia type M4EO was made.The diagnosis was confirmed with the immunologic analysis of born marrow cells with FACS.Chromosome and G-banding analyses revealed her karyotype of46,XX,inv(16)/47,XX,inv(16),+8(2/22).The plaque lesions of psoriasis were regressed after allogeneic bone marrow transplantation and the symptoms of AML were resolved.Conclusion It is the first case report of psoriasis vulgaris associated with acute myelogenous leukemia M4EO which responded to allogeneic bone marrow transplantation.