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Case Report: Central nervous system blast crisis of chronic myeloid leukaemia misdiagnosed as tubercular meningitis

机译:病例报告:慢性髓性白血病的中枢神经系统爆炸危险被误诊为结核性脑膜炎

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摘要

Chronic Myeloid Leukaemia (CML) presenting with isolated Central Nervous System (CNS) blast crisis is an uncommon entity. A 22-year-old man, diagnosed with chronic phase CML in 2011 and was in haematological and cytogenetic remission until July 2016, had acute onset headache and vomiting with meningeal signs and was admitted elsewhere, investigated by brain imaging and cerebrospinal fluid (CSF) analysis and suspected to have tubercular meningitis, for which steroids and antitubercular medications were started. The patient’s sensorium further deteriorated, and Ventriculoperitoneal shunt surgery was done for hydrocephalus by a neurosurgeon. After 2 months of the illness, he was admitted to our hospital with a persistent headache, vomiting and altered sensorium. CSF for cytospin confirmed myeloid blasts. He was still in haematological remission. So, a diagnosis of isolated CNS blast crisis was made. The patient was started on triple intrathecal chemotherapy and cranial radiotherapy. He had improvement with treatment and is still in remission.
机译:慢性粒细胞白血病(CML)表现为孤立的中枢神经系统(CNS)爆炸危险,是一种罕见的个体。一名22岁男子于2011年被诊断为慢性期CML,直到2016年7月才获得血液学和细胞遗传学缓解,患有急性发作性头痛和呕吐并伴有脑膜症状的呕吐物,并在其他地方被接受,接受了脑成像和脑脊髓液(CSF)检查分析并怀疑患有结核性脑膜炎,为此开始使用类固醇和抗结核药物。患者的感觉层进一步恶化,神经外科医生对脑积水进行了脑室-腹膜分流手术。患病2个月后,他因头痛,呕吐和感觉改变而被送进我们医院。 CSF用于胞旋证实的髓母细胞。他仍在血液学缓解中。因此,作出了孤立的CNS爆炸危机的诊断。该患者开始进行三次鞘内化疗和颅骨放疗。他的治疗有所改善,目前仍在缓解中。

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