Acute systemic reticulo-endotheliosis terminating as a monocytic leukaemia

Abstract

have commanded an inter-T est out of all proportion to the frequency of their occurrence but not unrelated to their importance.Frazer suggested, in 1935, that they might provide a link between local tumour growth and systemic malignant disease, and this seems not unlikely, since they embrace such divergent types as the localized eosinophilic granuloma of bone and those with widespread involvement of the haemopoietic or lymphatic systems, such as Letterer-Siwe disease and the histiocytic medullary reticulosis of Scott and Robb-Smith.This report of a single case history appears important, since the child presented with systemic reticulo-endothe-Iiosis and progressed while under treatment with A.C.T.H. to a rapidly fatal monocytic leukaemia of the Schilling type. CASE REPORTA boy, aged 6, was admitted June 18, 1951, with a history of becoming progressively pale and listless during the previous two weeks, having a persistent cough, and complaining of ains in his limbs and abdomen.His parents {ad noted "blood spots'' on his face at varying times during this period.He had not taken any drugs recently.T h e personal and family history were noncontribu tory.H e weighed 39 lb.T h e mucosae were pale; the conjunctivae, icteric.There were petechiae on the left side of the palate.Small discrere nodes were palpable on both sides of the neck, in the left axilla, and in both groins.T h e temperature was normal.T h e spleen and liver could not be felt.Hiss's test was negative.Roentgenograms of the chest showed moderate enlargement of the hilar nodes; roentgenograms of the long bones appeared normal.Subsequent to admission there was a gradual deterioration in his condition with generalized petechiae coming in crops and with enlarging From the Surgical and Pathological departments of the Belgrave Hospital for Children, London, England.We are grateful to Dr. Mary Wilmers under whose care the patient was first admitted, to Professor Magnus for the report on the lymph node, and to the laboratory staff of the Belgrave Hospital for assistance in the many investigations.