A 67-year-old male patient with a history of chronic alcoholism.
Five weeks before admission, the patient suddenly presented bilateral hearing loss.
The day of admission presented right brachio-crural paresis of sudden installation, associated with qualitative commitment of consciousness, which was taken to the Emergency Hospital Dr. Sotero del Rio.
On physical examination, the patient was alert, disoriented, with Glasgow 14 (V4M6O4); hemodynamically stable, afflicted, polypneic (30/min); well hydrated and perfused, lack of compliance.
b palpable ridge crackles; rhythmic heart in two stages, without murmurs; blushing abdomen, depressible, liver 2 cm normal
Neurological examination showed right brachio-crural motor deficit (M3 upper and lower limb), with ipsilateral extensor plantar reflex, without meningeal signs.
Laboratory tests
Hct: 32.4%; Leukocytes: 800,000 x mm3 (12% bacilliforms, 8% juveniles, 15% myelocytes); Platelets: 135000 x mm3; Creatininemia: 13 mEq/dL
Chest X-ray: predominantly basal bilateral interstitial infiltrate, without cardiomegaly.
Income arterial gas
PaO2: 3 mmHg
F1O2 : 0,21
SaO2: 1%
PaCO2: 53 mmHg
pH: 7.20
HCO3: 20 mEq/L
Due to the marked blood gas analysis, discordant with the clinical signs and pulse oximetry (93% with environmental oxymetry) arterial gas was taken again during the 3 minutes, obtaining a sample in ice close to:
Control arterial gas
PaO2: 65 mmHg
SaO2: 93%
PaCO2: 33 mmHg
pH: 7.20
HCO3: 19.4 mEq/L
arterial blood gas results were interpreted as spurious secondary to hyperleucocytosis, so they were not considered to define patient management.
He was hospitalized with the diagnosis of probable chronic myeloid leukemia (CML), hearing loss and hemiparesis secondary to hyperviscosity syndrome, starting treatment with hydroxyurea and intravenous hydration with saline, showing qualitative improvement of consciousness.
Leukocyte count decreased progressively, with improvement in PaO2 and SaO2 levels proportional to the decrease in leukocytes, reaching normal levels at 10 days.
It is important to highlight that her blood glucose and kalemia values remained normal throughout the hospitalization.
Chromosomal translocation 9:22 was demonstrated, confirming the diagnosis of CML.
1.
The patient became conscious and oriented, in 15 cases, persisting with severe bilateral hypoacusis and right brachio-crural paresis, with no changes regarding admission.
He continued treatment for CML with hydroxyurea, indicating hospital discharge with an outpatient plan.
