Successful intra-articular chemotherapy for relapsed acutemyeloid leukaemia infiltrating the knee joint

A 76-year-old male presented in September 1999 with a Hb of

6Æ8 g/dl, white cell count 57 · 109/l and platelet count

207 · 109/l. Examination of peripheral blood and bone

marrow (top left) films led to a diagnosis of M5 acute myeloid

leukaemia.

The patient was treated with one course of mitoxantrone,

cytarabine and etoposide. He became septicaemic and required

intensive care admission. He recovered to a good functional

status and further chemotherapy was not administered. He

remained well until February 2000 when he presented with

three small nodules in his skin, white cell count 2Æ9 · 109/l,

neutrophil count 1Æ2 · 109/l, Hb 11Æ3g/dl, platelets 118 · 109/l

and bone marrow relapse. This and subsequent blood films

showed only occasional blast cells.

The patient was given one further course of chemotherapy

(daunorubicin, cytarabine and 6-thioguanine). Despite a

reduction in bone marrow disease, his skin lesions progressed.

In April 2000, he presented with progressive skin lesions

(right) and an acutely painful swollen right knee. By June 2000,

he was unable to walk.

Twenty millilitre of synovial fluid from the right knee was

aspirated. Cytospins showed blasts (bottom left) and a

diagnosis of intra-articular leukaemia was made. He was given

intra-articular methorexate (10 mg) for palliative treatment.

This relieved the pain and swelling for 2 months and the

patient was able to walk again. He died of progressive

leukaemia in August 2000.

Intra-articular leukaemia is rare. In this patient, bone

marrow, skin and intra-articular relapse were present with

minimal evidence of peripheral blood leukaemia. Intra-

articular methotrexate has been used in rheumatoid arthritis.

As shown in this case, it can also be useful in intra-articular

leukaemia.

Khaled Ramadan1

Mary Cahill2

1Haematology SpR, Belfast City Hospital, Belfast, UK, and 2Consultant

Haematologist, Department of Haematology, Mid-Western Regional

Hospital, Dooradoyle, Limerick, Ireland. E-mail: mcahill@mwhb.ie

images in haematology

258 ª 2004 Blackwell Publishing Ltd, British Journal of Haematology, 124, 258