高ALP血症を呈した原発不明播種性骨髄癌症の1例

Disseminated Carcinomatosis of Bone Marrow of Unknown Origin with Hyperphosphatasia : Case Report

　骨盤の造骨性変化，貧血，ALP高値を呈し，生検後，急速にDIC（disseminated intravascular coagulation）が進行した播種性骨髄癌症の1例を経験したので報告する．症例：58歳，男性．他院でALP高値，骨盤の造骨性変化，骨シンチグラムでびまん性の集積像を指摘された．腸骨より生検術を施行したところ，貧血と血小板減少が急激に進行しDICに移行して死亡した．播種性骨髄癌症は，一般的に腰背部痛，貧血，血小板減少を特徴とし，高ALP血症を呈する場合もある．原因不明の腰背部痛に貧血，血小板減少，高ALP血症を認めた場合，播種性骨髄癌症も考慮すべきと考えた．

　We report a case of disseminated carcinomatosis of bone marrow with disseminated intravascular coagulation (DIC) deteriorating after open biopsy. A 58-year-old man with low back pain presented with hyperphosphatasia, sclerotic change of the pelvis, and super bone scan on bone scintigraphy. We undertook open biopsy of the ilium. After surgery, his anemia and thrombocytopenia worsened, eventually leading to DIC. He died of a brain hemorrhage. Disseminated carcinomatosis of the bone marrow, characterized by anemia, thrombocytopenia, and low back pain, has a dismal prognosis. It is thus advisable to suspect disseminated carcinomatosis of the bone marrow for a patient pesenting with low back pain, anemia, thrombocytopenia, and hyperphosphatasia.