Miliary Tuberculosis Associated with Chronic Neutrophilic Leukemia

Sugino, Keishi; Gocho, Kyoko; Ota, Hiroki; Kobayashi, Minaho; Sano, Go; Isobe, Kazutoshi; Takai, Yujiro; Izumi, Hiroto; Kuraishi, Yasushi; Shibuya, Kazutoshi; Homma, Sakae

doi:10.2169/internalmedicine.48.2080

Cited by 12 publications

(15 citation statements)

References 17 publications

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“…In one recent report of nine patients, one patient had documented toxic granulation and Döhle bodies and it was stated that these were common morphological features in patients with a CSF3R mutation (Maxson et al , ). Ring neutrophils were noted in four patients in a single publication (Kanoh et al , ) and one patient had neutrophil hypersegmentation without other abnormal features (Sugino et al , ). Nine cases included some reference to morphology but this was insufficient for a judgement to be made as to what changes were actually present.…”

Section: Resultsmentioning

confidence: 99%

Chronic neutrophilic leukaemia and plasma cell‐related neutrophilic leukaemoid reactions

Bain

Ahmad

2015

Br J Haematol

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SummaryMany cases reported as 'chronic neutrophilic leukaemia' have had an associated plasma cell neoplasm. Recent evidence suggests that the great majority of such cases represent a neutrophilic leukaemoid reaction to the underlying multiple myeloma or monoclonal gammopathy of undetermined significance. We have analysed all accessible reported cases to clarify the likely diagnosis and to ascertain whether toxic granulation, D€ ohle bodies and an increased neutrophil alkaline phosphatase score were useful in making a distinction between chronic neutrophilic leukaemia and a neutrophilic leukaemoid reaction. We established that all these changes occur in both conditions. Toxic granulation and D€ ohle bodies are more consistently present in leukaemoid reactions but also occur quite frequently in chronic neutrophilic leukaemia. The neutrophil alkaline phosphatase score is increased in both conditions and is of no value in making a distinction.Keywords: monoclonal gammopathy of undetermined significance, multiple myeloma, chronic leukaemia, chronic neutrophilic leukaemia.As defined in the 2008 World Health Organization (WHO) classification (Bain et al, 2008), chronic neutrophilic leukaemia (CNL) is a Philadelphia-negative myeloproliferative neoplasm (MPN) characterized by a white cell count (WBC) of at least 25 9 10 9 /l with segmented neutrophils and band forms comprising more than 80% of leucocytes, circulating blast cells less than 1%, immature granulocytes (promyelocytes, myelocytes and metamyelocytes) less than 10% and monocytes less than 1Á0 9 10 9 /l. There is no evidence of another MPN or a myelodysplastic syndrome (MDS), no dysplasia in any lineage and no evidence of a myelodysplastic/myeloproliferative neoplasm (MDS/MPN). There should be no identifiable cause of physiological neutrophilia or, if such is present, there should be evidence of clonality. From the early 1900s onwards, more than 200 cases of CNL have been described but many of these would not meet current diagnostic criteria. The first known case meeting current criteria is that described by Tuohy in 1920 as 'A case of splenomegaly with polymorphonuclear neutrophil hyperleukocytosis' (Tuohy, 1920). However four other early cases had atypical features and appear more likely to have been primary myelofibrosis (Rathery, 1902;Hirschfeld, 1904;Emile-Weil & S ee, 1932). It is important to distinguish CNL from the neutrophilic leukaemoid reaction that can occur with multiple myeloma (plasma cell myeloma) and monoclonal gammopathy of undetermined significance (MGUS), which is attributable to cytokine release by neoplastic plasma cells. We were interested in reports of toxic granulation and D€ ohle bodies in patients considered to have CNL and we have also observed these phenomena in neutrophilic leukaemoid reactions. As toxic granulation is uncommon in myeloid neoplasms, this caused us to question whether some cases diagnosed as CNL might in fact have had a leukaemoid reaction to a plasma cell neoplasm. An increased neutrophil alkaline phosphatase (NAP) ...

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Section: Resultsmentioning

confidence: 99%

Chronic neutrophilic leukaemia and plasma cell‐related neutrophilic leukaemoid reactions

Bain

Ahmad

2015

Br J Haematol

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“…Hematologic abnormalities are frequently described and pancytopenia is profound in hematolgic diseases. In malignant diseases, the incidence of miliary TB is about 3% and it rarely reported in hematologic diseases [18,19]. …”

Section: Discussionmentioning

confidence: 99%

Miliary tuberculosis occurred after immunosuppressive drug in PNH patient with completely cured tuberculosis; a case report

Lee

Gong

Lee

et al. 2012

Ann Clin Microbiol Antimicrob

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Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal disorder that presents with hemolytic anemia, marrow failure and thrombophilia. During acute attacks, corticosteroid can alleviate the hemolytic paroxysm, but the prolonged administration induces serious toxicity including immunosuppression. So American thoracic society (ATS) for tuberculosis (TB) recommends prophylactic anti-TB medication in patients with a long-term steroid therapy. However, in the patient who was treated for active TB in the past, there are no guidelines of the test for determining patients who have latent TB infection (LTBI) and no recommendations of TB prophylaxis if there is no evidence of reactivation at present. A 40-year-old male patient presented with fever and aggravated weakness for a week. He was diagnosed with PNH a month ago and took corticosteroid for 3 weeks. In the past, he was diagnosed with pulmonary TB and completely cured after treatment. According to guideline, he was not indicated with TB prophylaxis. However, he caught miliary TB, progressed to acute respiratory distress syndrome. We experience this embarrassing case, and emphasize the need to investigate multicentral TB prevalence and to make the guidelines of anti-TB medication in subgroups of hematologic diseases including PNH.

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“…Although cases of CNL have been found occasionally to carry the JAK2V617F mutation, similarly to cytogenetic aberrations, this is a broadly specific finding for myeloid neoplasia and the primary value to date has been to corroborate clonality. Since the initial discovery of the JAK2V617F mutation, several case reports of CNL meeting WHO criteria carrying this mutation the have been reported [6,18,[54][55][56][57][58][59][60][61][62]. The relative frequency of these recent case reports must be interpreted in the light that the JAK2V617F was often the main reason for reporting and a recent series of fourteen WHO defined CNL carrying CSF3R mutations, all of which were negative for JAK2V617F [7].…”

Section: Cytogenetics and Cnlmentioning

confidence: 99%

Chronic neutrophilic leukemia 2016: Update on diagnosis, molecular genetics, prognosis, and management

Elliott

Tefferi

2016

American J Hematol

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Chronic neutrophilic leukemia (CNL) is a potentially aggressive myeloproliferative neoplasm, for which current WHO diagnostic criteria include leukocytosis of ≥25 × 109/L (of which >80% are neutrophils) and with <10 and <1% circulating immature granulocytes and blasts, respectively without dysplasia, clinical, or molecular criteria for other myeloproliferative disorders, nor an identifiable cause for physiologic neutrophilia in the absence of markers of myeloid clonality. Such a pathogenic clonal marker has now been identified as a somatic activating mutation of CSF3R, most commonly CSF3R T618I, thus demanding revision of the current WHO diagnostic classification to include the molecular criterion of mutated CSF3R. The clinical presentation, disease course and prognosis of CSF‐R mutated CNL have been recently outlined. Co‐operative mutations in SETBP1 and ASXL1 appear to be of prognostic significance and correlate with disease progression. Advances in the understanding of the molecular pathogenesis of CNL, have not yet fully translated into satisfactory therapeutic strategies, but the foundations for these are strengthening. Am. J. Hematol. 91:342–349, 2016. © 2015 Wiley Periodicals, Inc.

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Miliary Tuberculosis Associated with Chronic Neutrophilic Leukemia

Abstract: We report a case of miliary tuberculosis associated with chronic neutrophilic leukemia (CNL)

Cited by 12 publications

References 17 publications

Chronic neutrophilic leukaemia and plasma cell‐related neutrophilic leukaemoid reactions

Chronic neutrophilic leukaemia and plasma cell‐related neutrophilic leukaemoid reactions

Miliary tuberculosis occurred after immunosuppressive drug in PNH patient with completely cured tuberculosis; a case report

Chronic neutrophilic leukemia 2016: Update on diagnosis, molecular genetics, prognosis, and management

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