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白血病樣 反應을 보인 汎發性 結核의 例

Dissemiriated Tuberculosis With Leukemoid Reaction

최신의학 1959년 2권 1호 p.83 ~ 86
李相龍, 南廷直, 李鎬永,
소속 상세정보
李相龍 (  ) - 延世醫大 內科
南廷直 (  ) - 延世醫大 內科
李鎬永 (  ) - 延世醫大病理學敎室

Abstract


Introduction
It is necessary to have frequently autopsy for definite diagnosis, correct medical treatment and development of medical-´knowledge in Korea. I would like to report, a experiented case in our medical department having definite diagnosis^by postmortem examination.
Discussion
A 32year old young Korean man was admitted to this hospital with chief complaints of general weakness, dyspnea and loss of body weight during the last one year, and denied tuberculosis, any other diseases except for rheumatoid arthritis and hemorroid in his past history. Physical examination showed essentially negative except for low blood pressure(30/50mm Hg.) hemorragic evidence with white spots in right eye ground, leukopenia(2550), myelocyte(58%), few mye loblast, thrombocytopenia(7320), in peripheral bloa3, 22% of myelocytes, 25% of normoblast, 0.4% of megaloblast, in bone marrow, positive of eschoria coliin urine culture, negative in blood´ culture, normal chest X-ray studies without skull andskeletal survey and normal electrocardiography.
During his hospitalization, he had whole blood transfussion, penicillin shorts and cortisone ranging 100-300mg per-day with well control to normal from moderate fever. However, he had persisted no change. I would like in blood picture, soft liver palpable about i finger breadth below at costal margin in later, admission. But no palpable spleen, normal limits of.fasting blood suger and liver function tests. Otherwise disseminated tuberculosis spread to many placesof iimphnodes and marked leukemoid reaction in bone marrow, liver and spleen were pointed out as autopsy report. Is is necessary to discus frequently whether to give or not antituberculous chemicaltherapy before clinical steroid therapy given in these cases.
Pathological Finding
Final anatomical pathological diagnosis;
1) caseous tuberculosis of limphnodes. (pulmonary hilar, mediastinal, mesenteric and peripancreatic)
2) caseous miliary tuberculosis of liver and apleen.
3) marked -chronic tuberculous pleuritis, bilateral.
4) marked Ieukernoid reaction of hemotopoietic tissue in the bone marrow.(no evidence of ieukemis.)
5) marked pulmonary edema, chronic passive congeation with mild hypostatic pheumonia of both lungs.
6) chronic passive congestion of all -viscera.
7) marked toxic nephrosis of´kidneys.
8) toxic degeneration of hepatic cord cells
9) cerebral edema, moderate.
10) internal hemorrhoides.
Sumarry.
A 32 yearold yo´Ung Korean man with marked anmic, febrile condition was compared clinical findings with poatmortem examination Disseminated tuberculosis was followed with leukemoid reaction especially similanty aleukemic leukemia and thrombocytopenia in blood picture. But no change in blood picture seen although clinically improved by steroid therapy.
It is point out in this case that it is necessary to have autopsy frequently in our medical field for development or medical knowledge.

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