ステロイドパルス療法にて軽快した膵頭十二指腸切除術後血球貪食症候群の１例

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  • A CASE OF HEMOPHAGOCYTIC SYNDROME AFTER PANCREATICODUODENECTOMY SUCCESSFULLY TREATED BY STEROID PULSE THERAPY

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The patient was a 73-year-old woman. She underwent pancreaticoduodenectomy (gastropancreatic anastomosis) and local lymph node dissection excision (D1) to treat cancer of the lower part of the bile duct. One day after the surgery, the patient showed a sharp decrease in WBC (0.7×103/μl) accompanied by high fever. Hemophagocytic syndrome was suspected and the patient received bone marrow puncture. The bone marrow specimen showed signs of hemophagocytosis by macrophages, allowing the diagnosis of hemophagocytic syndrome (HPS). On the same day, pulsed steroid therapy was started. This therapy resulted in improvement in hematological findings and systemic condition. The patient was discharged very much improved. Another test immediately before discharge showed that the bone marrow normalized. So far as postoperative HPS is concerned, the early diagnosis is crucial and, to make it, the possible onset of this disease needs to be borne in mind in managing postoperative patients. In the present case, early detection and early treatment of HPS after pancreaticoduodenectomy was possible by performing bone marrow puncture, and the condition subsided in response to pulsed steroid therapy. This case is presented in this paper with a review of the literature.

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