mercaptopurine and Hypothyroidism

We report on the thyroid involvement with Langerhans cell histiocytosis (LCH) in a 3-year-old male. The patient presented with goiter and primary hypothyroidism. His goiter caused life-threatening airway obstruction. He developed locally invasive disease 4 years after his response to LCH therapy. LCH should be suspected as a cause of goiter and thyroidectomy is recommended.

Topics: Airway Obstruction; Carcinoma, Papillary; Child, Preschool; Combined Modality Therapy; Goiter; Histiocytosis, Langerhans-Cell; Humans; Hypothyroidism; Male; Mercaptopurine; Methotrexate; Prednisone; Thyroid Diseases; Thyroid Neoplasms; Thyroidectomy; Thyroiditis, Autoimmune

We describe a case of acute leukemia with t(4;11) (q21;q23) in a 3-month-old girl suffering from congenital hypothyroidism. The blast cells were cytochemically and immunologically classifiable as acute lymphoblastic leukemia of an early B-cell lineage (HLA-DR +, B4 +, CALLA-). but we treated this patient with a protocol designed mainly for acute nonlymphocytic leukemia, employing Adriamycin, vincristine, and cytosine arabinoside. Although the prognosis of this type of leukemia is known to be extremely poor, our patient is currently alive and in continuous complete remission lasting 35 months to date. This case may demonstrate a potential alternative therapeutic strategy for acute leukemia with t(4;11) as well as clinical evidence for the mixed-lineage characteristics of this condition. However, the pathogenetic role of congenital hypothyroidism in the development of acute leukemia is still uncertain.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cell Differentiation; Chromosomes, Human, Pair 11; Chromosomes, Human, Pair 4; Congenital Hypothyroidism; Cranial Irradiation; Cytarabine; Doxorubicin; Etoposide; Female; Humans; Hypothyroidism; Infant; Mercaptopurine; Methotrexate; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Remission Induction; Translocation, Genetic; Vincristine