Acute lymphocytic leukemia after fulminant varicella associated with severe neutropenia. (Letters to the Editor).

To the Editor: In my opinion, the patient described in the article by Helft et al (1) had leukemia to start with, because the patient was in a pancytopenic state. In addition, trephine bone marrow biopsy was not performed, so the leukemia could have been missed, especially if the marrow was patchily hypoplastic. Moreover, the high serum lactate dehydrogenase and CD 10 positivity also favor a diagnosis of leukemia. The role that growth factors played in the genesis of full-blown cancer is difficult to determine. I think that all patients with pancytopenia should undergo trephine biopsy so that the real diagnosis can be made.

Bushra Moiz, MBBS, MCPS, FCPS

Department of Pathology

Jinnah Medical College

University of Karachi

Karachi, Pakistan

Reference

(1.) Helft DA, Correa H, Rojas P, Warrier RP. Acute lymphocytic leukemia after fulminant variceila associated with severe neutropenia. South Med J 2002;95:1074-1075.

In Reply: Dr. Moiz's comments on the role of bone marrow biopsy are appropriate. Bilateral posterior iliac crest biopsies were performed and reviewed by the pathology department. The sections showed marked hypocellularity but did not show any evidence of acute lymphoblastic leukemia. Bone marrow aspirate, biopsy, and chromosomal studies of the initial marrow were not suggestive of acute lymphoblastic leukemia. Immunophenotyping showed a slight increase in early pre-B cells in the original marrow, as my coauthors and I described in our report. (1)

Rajesekharan P. Warner, MD, FAAP

Center for Cancer and Blood Disorders

Children's Hospital of New Orleans 

Department of Medicine

Louisiana State University Health Sciences Center

New Orleans, LA

Reference

(1.) Helft DA, Correa H, Rojas P, Warrier RP. Acute lymphocytic leukemia after fulminant varicella associated with severe neutropenia. South Med J 2002;95:1074-1075.