Clinical Experience of Management of Lower Leg Pain due to Chloroma of Lumbosacral Bone in Chronic Myelogenous Leukemia

만성골수성 백혈병 환자에서 발생한 요천추부 Chloroma로 인한 좌하지통증의 치료경험 1예 보고

Chloroma is a localized myeloblastic tumor which may develop during the course of myelogenous leukemia or as a presenting sign of the disease. A 47-year-old female diagnosed as chronic myelogenous leukemia in her hematologic remission period complained of left lower leg pain. The lumbar-spine series showed multiple osteolytic changes in the left lateral border of the lumbar spine. An inhomogenous soft tissue mass involving left lateral aspects of lumbar vertebrae was identified by CT-scanning. At the first pain attack, lumbar epidural steroid and local anesthetic injection could abolish her pain and the patient could go a few days without pain. The following radiation therapy could also improve the symptom and retain the pain free interval. One month later, a second pain attack occurred and lumbar and caudal epidural steroid and local anesthetic injections could result only in an incidental relief of pain. Radiation and chemotherapy were started but failed to relieve pain. A neurolytic block was considered but the patient's general condition was aggravated and even verbal communication with her became impossible.