TITLE:
Simultaneous Diagnosis of Myeloid Sarcoma of the Jaw and Mycobacterium tuberculosis Infection
AUTHORS:
Luís Arthur Flores Pelloso, Sandra Serson Rohr, Mihoko Yamamoto, Maria de Lourdes L. F. Chauffaille
KEYWORDS:
Myeloid Sarcoma; Mycobacterium tuberculosis; Granulocytic Sarcoma
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.4 No.6,
July
17,
2013
ABSTRACT: Granulocytic or myeloid sarcoma (MS)
is a rare neoplastic condition consisting of a tumor mass of myeloid blasts
with or without maturation occurring at an anatomical site other than the bone
marrow the association between tuberculosis and MS is extremely rare. A
21-year-old female patient presented cough, sore throat and a suppurative
swollen gum for 10 days prior to hospital admission. Physical examination
revealed moderate pallor and swollen inferior gum. CBC revealed Hb6.5 g/dL, hematocrit 18.4% MCV 97 fL MCH 34 pg,
WBC 18.5 ′ 109/μL (1 My/3 Bt/69 Sg/1 Eo/0 Ba/20 Ly/6
Mo), Platelets 43 ′ 109/μL. The peripheral blood smear
presented with 3% blast
cells (type 1) and granulocytic dysplasia. Bone marrow biopsy showed 100% cellularity. 50% of cells were from granulocytic precursors, diagnosis of
granulocytic sarcoma. The diagnosis of AML was established: granulocytic
sarcoma with massive gum infiltration (immature granulocytic cells) and 10% of
blasts in bone marrow. The patient received induction chemotherapy (3 + 7 daunorubicin 90 mg/m2), and gum tissue culture was positive for Mycobacterium tuberculosis.
Simultaneously, a qRT- PCR test confirmed the
same bacteria in the gum tissue.
Patient treated with isoniazid, rifampicin, pyrazinamide and ethambutol
ciprofloxacin and amikacin). Remission was achieved and the patient was
submitted for consolidation/ intensification
(HiDAC x3) schema and referred to allogeneic HSCT. After induction and full
hematological recovery there was no further evidence or recurrence of fever and
lytic lesions. Currently patient is under CR and ling follow up (48 months) did
not show recurrence of either AML or tuberculosis.