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August 1, 1977

Erythroleukemia (Di Guglielmo's Disease): Occurrence 28 Years After Thorium Administration

JAMA. 1977;238(5):423. doi:10.1001/jama.1977.03280050063025

ERYTHROLEUKEMIA (Di Guglielmo's disease) is considered to be a variant of acute myeloblastic leukemia in which the bone marrow contains increased numbers of abnormal, bizarre erythroid precursors as well as increased numbers of myeloblasts. The development of acute leukemia (predominantly but not exclusively myeloblastic) after exposure to various forms of ionizing irradiation is well known. A few cases of leukemia occurring after intravenous injection of thorium dioxide (Thorotrast) have been reported.1 We saw a patient who had PAS-positive erythroleukemia with chromosomal hypodiploidy 28 years after he had received thorium dioxide as a radiographic contrast agent.

Report of a Case  A 56-year-old man was hospitalized for fever of three weeks' duration. Results of physical examination on admission were unremarkable. Initial CBC count showed a hematocrit concentration of 32%; platelets, 85,000/cu mm; and WBCs, 5500/cu mm, with 4% neutrophils, 28% eosinophils, 68% atypical lymphocytes, and 28 nucleated RBCs per 100 WBCs.