Leukaemia, Amyloidosis, and Renal Vein Thrombosis in Irradiated Ankylosing Spondylitis

Penfold, John B.; Rhys-Lewis, R. D. S.

doi:10.1136/bmj.2.5052.1034

Cited by 5 publications

(2 citation statements)

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“…Ankylosing spondylitis-though accounting for fewer cases-is also capable of giving rise to it (Enrievaara and Oka, 1963. See also Bayles, 1943 ;Teilum and Lindahl, 1954;Halford and Clark, 1957;Penfold and Rhys-Lewis, 1957;Clinicopathological Conference, 1968). It is of interest that Gillman and Gilbert (1955) encountered generalised amyloidosis in a baboon that suffered from a skeletal disease with some of the features of ankylosing spondylitis.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic Haemorrhage From the Bladder Due to Unrecognised Secondary Amyloidosis

Missen

Tribe

2008

British Journal of Urology

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SUMMARY We report the cases of a 41‐year‐old man, who died of severe and intractable hzmorrhage from the urinary bladder, and of a 55‐year‐old woman in whom such hzmorrhage ushered fatal urzmia. He had suffered from severe ankylosing spondylitis with involvement of proximal limb‐joints for 14 years, and she from severe rheumatoid disease for 20 years with episodes superimposed pyogenic arthritis during the last 3 months. Both had widespread secondary amyloidosis, unrecognised in life, with severe involvement of the blood‐vessels of the vesical submucosa‐the source of the hzmorrhage‐and of the kidneys. Factors probably contributing to the initiation of bleeding were severe hypertension in the man, septicremia (Streptococcus pyogenes) and prolonged hypotension in the woman, and a considerable degree of renal failure both. It is suggested that—whenever exploratory cystotomy fails to reveal the cause of continuing bleeding from the bladder—a sample of the vesical wall should be submitted to microscopy.

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Section: Discussionmentioning

confidence: 99%

Catastrophic Haemorrhage From the Bladder Due to Unrecognised Secondary Amyloidosis

Missen

Tribe

2008

British Journal of Urology

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“…The cause of this translocation is unknown, although exposure to ionizing radiation is likely to be a risk factor (7). Previous studies have demonstrated a dose-dependent risk of CML in patients with cancer who undergo radiation therapy (8,9) and experience repeated exposure to diagnostic radiography (7).…”

Section: Introductionmentioning

confidence: 99%

Chronic myeloid leukemia following repeated diagnostic X‑ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis: A case report and literature review

Gong

et al. 2017

Oncol Lett

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Abstract. Previous studies have indicated that X-ray irradiation may increase the risk of chronic myeloid leukemia (CML), and the incidence of spontaneous pneumothorax in patients with ankylosing spondylitis (AS) is higher than in the general population. Patients with AS usually develop spontaneous pneumothorax several years after the diagnosis of AS. The present study reports the unusual case and complicated clinical history of a 29-year-old man with recurrent pneumothorax and AS, who developed CML following repeated exposure to low doses of radiation via diagnostic X-rays and chest computed tomography imaging. Pneumothorax was diagnosed prior to AS in this patient; the present case report highlights the importance of recognizing AS as a possible underlying cause of recurrent spontaneous pneumothorax. Patients with AS may be more sensitive to injury via X-ray-derived radiation, and even small diagnostic doses may be associated with CML. Diagnostic X-ray exposure should therefore be limited to reduce the risk of radiation-associated malignancies, including CML, particularly in patients with AS. IntroductionAnkylosing spondylitis (AS) is a systemic, multifactorial, chronic rheumatic disease that affects the joints of the axial skeleton (1). A thorough physical examination, in conjunction with family history analysis, consideration of the patient's individual medical history, X-ray imaging and serum human leukocyte antigen (HLA)-B27 testing, is required for an accurate diagnosis (2). Previous research has indicated that the incidence of spontaneous pneumothorax in patients with AS is 0.29%, higher than that observed in the general population (1).Although the underlying etiology of spontaneous pneumothorax remains unknown, it is an uncommon lung disease that disrupts respiration in otherwise healthy men who tend to be tall and thin (3). Spontaneous pneumothorax results from the rupture of a subpleural emphysematous bleb typically located at the apex of the lung, leading to the accumulation of air in the pleural cavity (3). During the course of diagnosis and treatment, X-ray imaging is often utilized in patients with spontaneous pneumothorax (4).Chronic myeloid leukemia (CML) is characterized by the abnormal growth of mature myeloid cells; it has been associated with translocation involving chromosomes 9 and 22, resulting in the formation of the Philadelphia chromosome (5,6). The cause of this translocation is unknown, although exposure to ionizing radiation is likely to be a risk factor (7). Previous studies have demonstrated a dose-dependent risk of CML in patients with cancer who undergo radiation therapy (8,9) and experience repeated exposure to diagnostic radiography (7).Our previous report described the case of a patient with AS who was diagnosed with CML following repeated chest radiography and computed tomography (CT) (10); the report focused primarily on a possible association between low-dose X-ray-derived radiation exposure and CML. However, a recent follow-up revealed that this patient experienced mild l...

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The incidence of leukemia and related diseases in patients with rheumatoid (ankylosing) spondylitis treated with X‐ray therapy

Silberberg

Frohman

Duff

1960

Arthritis & Rheumatism

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In a series of 496 rheumatoid spondylitis patients treated with x-ray, the authors have reported an incidence of leukemia over 17 times greater than expected in a comparable population. No conclusion can be drawn with respect to the exact nature of dose-response relationship in leukemogenesis. Four of the reported leukemias arose from myeloid reticular elements of the bone marrow; the fifth case is of undetermined origin. Since the chief use of x-ray therapy under these circumstances is as an analgesic, it would seem unwise to compound the risk of developing leukemia in these patients by its continued use unless all other forms of symptomatic treatment have failed and the patient and the physician mutually accept the possibility of this increased hazard.Super le base de 496 patientes tractate con radios X pro spondylitis rheumatoide, le autores reporta un incidentia de leucemia plus que 17 vices plus alte que ill0 expectate in un comparabile population de controlo. Nulle conclusion pote esser derivate con respecto a1 exacte natura del relation de dosage a responsa in le leucemiogenese. In quatro del reportate casos, le leucemia habeva su origine in elementos reticular myeloide del medulla ossee; in le quinte, le origine es indeterminate. Viste que le us0 principal del radiotherapia sub iste conditiones es ill0 de un analgesico, il pare pauco sage currer le risco del disveloppamento de leucemia in le patientes rheumatoide per le continue us0 de radiotherapia, excepte quando omne altere forma de tractamento symptomatic se ha provate van e quando tante le medico como etiam le patiente es conscie del hasardo inherente e accepta lo.

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Leukaemia, Amyloidosis, and Renal Vein Thrombosis in Irradiated Ankylosing Spondylitis

Cited by 5 publications

References 2 publications

Catastrophic Haemorrhage From the Bladder Due to Unrecognised Secondary Amyloidosis

Catastrophic Haemorrhage From the Bladder Due to Unrecognised Secondary Amyloidosis

Chronic myeloid leukemia following repeated diagnostic X‑ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis: A case report and literature review

The incidence of leukemia and related diseases in patients with rheumatoid (ankylosing) spondylitis treated with X‐ray therapy

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