Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Meningeal Infiltration of Tumor Cells and Elevated Interleukin-1β and Interleukin-6 in Cerebrospinal Fluid of a Patient with Adult T-cell Leukemia

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  • IMAIZUMI Rie
    Division of Hematology/Oncology, Jiaikai Imamura Hospital
  • FUJIWARA Hiroshi
    First Department of Internal Medicine, Faculty of Medicine, Kagoshima University
  • MATSUMOTO Tadashi
    Division of Hematology/Oncology, Jiaikai Imamura Hospital
  • MATSUMOTO Makoto
    Division of Hematology/Oncology, Jiaikai Imamura Hospital
  • MATSUSHITA Kakushi
    First Department of Internal Medicine, Faculty of Medicine, Kagoshima University
  • OHTSUBO Hideo
    First Department of Internal Medicine, Faculty of Medicine, Kagoshima University
  • HIDAKA Shiroh
    First Department of Internal Medicine, Faculty of Medicine, Kagoshima University
  • ARIMA Naomichi
    First Department of Internal Medicine, Faculty of Medicine, Kagoshima University
  • TEI Chuwa
    First Department of Internal Medicine, Faculty of Medicine, Kagoshima University

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Other Title
  • 髄膜への細胞浸潤，抗利尿ホルモン不適合分泌症候群(SIADH), 髄液中IL-6, IL-1βの上昇を合併したATL

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Abstract

A 73-year-old man with acute adult T-cell leukemia (ATL) in remission was re-admitted to our hospital due to drowsiness, headache, and bilateral knee joint pain on May 17, 1998. On admission, examinations revealed decreased serum sodium concentration (112 mEq/l), low plasma osmotic pressure (259 mOsm/l), and elevated antidiuretic hormone (5.6 pg/ml). Cerebrospinal fluid examination showed an increased number of abnormal flower-like lymphocyte (951/μl). Brain computed tomography and magnetic resonance imaging found no abnormality in the hypothalamus or pituitary gland. These findings yiebled a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Though ATL patients typically exhibit a variety of clinical symptoms, SIADH is rarely one of the complications. Further investigation showed that IL-1β and IL-6 concentrations were increased in spinal fluid but not in serum. Recently, it has been reported that exogeneous IL-6 is an inducer of ADH secretion, and that primary ATL cells and HTLV-I infected cell lines can produce IL-6. In this case, we speculated that IL-6 produced by ATL cells that infiltrated a cerebral lesion may have played an important role in the development of SIADH.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 41 (2), 140-145, 2000

    The Japanese Society of Hematology

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