tailieunhanh - Báo cáo y học: " Precursor B-cell acute lymphoblastic leukemia presenting as obstructive jaundice: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Precursor B-cell acute lymphoblastic leukemia presenting as obstructive jaundice: a case report. | Siddique et al. Journal of Medical Case Reports 2011 5 269 http content 5 1 269 WV journalof medical l rCASE REPORTS CASE REPORT Open Access Precursor B-cell acute lymphoblastic leukemia presenting as obstructive jaundice a case report 1 2 2 1 3 2 Muhammad N Siddique Muhammad Popalzai Nelly Aoun Rabih Maroun Michael Awasum and Qun Dai Abstract Introduction Acute leukemias very rarely present with jaundice. Herein we report a case of precursor B-cell acute lymphoblastic leukemia that presented with jaundice in an adult. Case presentation A 44-year-old Hispanic man presented with right upper quadrant abdominal pain and jaundice. His initial blood work revealed pancytopenia and hyperbilirubinemia. Direct bilirubin was more than 50 of the total. His imaging studies were unremarkable except for hepatomegaly. All blood screening tests for various hepatocellular etiologies were normal. A diagnosis of precursor B-cell acute lymphoblastic leukemia was made upon liver biopsy. It also showed lymphocytic infiltration of the hepatic parenchyma leading to bile stasis. The diagnosis was subsequently confirmed upon bone marrow biopsy. The patient was treated with a hyperfractionated cyclophosphamide vincristine doxorubicin dexamethasone regimen. Conclusion Acute lymphoblastic leukemia should be one of the differential diagnoses that should be considered when initial work-up for jaundice is inconclusive. Some cases of acute lymphoblastic leukemia have been reported in both adults and children to have presented with the initial manifestation of jaundice but only a few had no radiographic evidence of biliary obstruction. Such presentation can pose a serious diagnostic dilemma for clinicians. This manuscript attempts to highlight it. Moreover we believe that if acute lymphoblastic leukemia presentations similar to this case continue to be reported in adults or children a specific immunophenotypic expression and cytogenetic abnormality may be found to be .