A 26-year-old asymptomatic female was seen by her primary care physician and routine laboratory testing was performed. Her white blood cell count was 240 X 10~9/L, hemoglobin was 14 g/dL, and platelet count was 196 X 10~9/L. The review of the peripheral smear and flow cytometry were compatible with B-cell acute lymphoblastic leukemia. Karyotype showed a translocation 4;11. Abundant lymphoblasts were present in the bone marrow aspirate (panel A). Treatment was begun with intrathecal methotrexate and high-dose chemotherapy; however, she terminated therapy in favor of a vitamin-based alternative approach. Two months later she developed lower extremity weakness and blurry vision. Complete blood count and differential revealed leukocytosis (989 X 10~9/L) with 80 percent lymphoblasts, normocytic anemia (9.8 g/dL), and thrombocytopenia (37 X 10~9/L). Computed tomography (panel B) and subsequent magnetic resonance imaging (panel C) of the brain showed scattered hyper-attenuating hemorrhagic foci in different stages of evolution. The spinal fluid did not show evidence of leukemic meningitis. She agreed to accept high-dose chemotherapy. A complete resolution of her neurologic symptoms occurred. Currently, she is being evaluated for allogeneic hematopoeitic stem cell transplantation.
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机译：她的初级保健医生看了一名26岁无症状的女性，并进行了常规实验室检查。她的白细胞计数为240 X 10〜9 / L，血红蛋白为14 g / dL，血小板计数为196 X 10〜9 / L。外周血涂片检查和流式细胞仪检查与B细胞急性淋巴细胞白血病兼容。核型显示易位4; 11。骨髓穿刺液中有大量淋巴母细胞（图A）。鞘内注射甲氨蝶呤和大剂量化疗开始治疗;但是，她终止了治疗，转而采用基于维生素的替代疗法。两个月后，她出现了下肢无力和视力模糊。全血细胞计数和差异显示白细胞增多症（989 X 10〜9 / L）和80％的淋巴母细胞，正常性贫血（9.8 g / dL）和血小板减少症（37 X 10〜9 / L）。脑的计算机断层扫描（图B）和随后的磁共振成像（图C）显示，在不同的演化阶段散在的高度衰减的出血灶。脊髓液未显示出白血病脑膜炎的迹象。她同意接受大剂量化疗。完全解决了她的神经系统症状。目前，她正在接受异基因造血干细胞移植的评估。
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