A Case of Acute Leukemoid Reaction after Thoracic Endovascular Aortic Repair with Difficulty of Diagnosis and Treatment

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  • Yanagi Shigeki
    Department of Cardiovascular Surgery, Kumamoto Central Hospital
  • Tamura Nobushige
    Department of Cardiovascular Surgery, Kumamoto Central Hospital
  • Tanaka Atsuhisa
    Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University
  • Taki Tomofumi
    Department of Cardiovascular Surgery, Kumamoto Central Hospital
  • Nakatsu Taro
    Department of Cardiovascular Surgery, Kumamoto Central Hospital
  • Kyo Shoichi
    Department of Cardiovascular Surgery, Kumamoto Central Hospital

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Other Title
  • TEVAR 術後に類白血病反応を呈し診断治療に難渋した1 例

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An 87-year-old man developed a multilocular saccular aneurysm of the descending thoracic aorta and experienced extensive inflammatory reaction; he was administered antibiotic therapy because infectious aortic aneurysm was suspected. Throughout the course, however, no fever was noted, and the results of blood culture and procalcitonin test were negative. Computed tomography scans showed minor changes in the aneurysm shape and few shadows surrounding soft tissue. Based on these findings, we ruled out infectious aneurysm and performed thoracic endovascular aneurysm repair (TEVAR) with the emphasis on the risk of aneurysm rupture. One day after the surgery, leukemoid reaction with an abnormally high white blood cell count up to 112800/μl was noted, and the patient developed rapidly progressive pyoderma gangrenosum in the bilateral groin. He showed no response to antibiotic therapy during the course and died of multi-organ failure 21 days after the surgery. The results of the autopsy showed marrow hyperplasia and increased immature leukocytes, which suggested surgery-induced blast crisis that resulted from the underlying chronic myelomonocytic leukemia. Although TEVAR was less invasive, it is important to fully evaluate the reasons for preoperative inflammation and its indications for surgery.

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