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

Ju,Fang‑He; Gong,Xu‑Bo; Xu,Ting‑Zhen; Jiang,Li‑Bin; Hong,Hui‑Hua; Wang,Zhen

doi:10.3892/ol.2017.7156

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

Authors:
- Fang‑He Ju
- Xu‑Bo Gong
- Ting‑Zhen Xu
- Li‑Bin Jiang
- Hui‑Hua Hong
- Zhen Wang
View Affiliations

Affiliations: Department of Respiratory Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang 310006, P.R. China, Department of Clinical Laboratory, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
Published online on: October 10, 2017 https://doi.org/10.3892/ol.2017.7156
Pages: 7495-7498

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

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.

View Figures

View References

1	Lee CC, Lee SH, Chang IJ, Lu TC, Yuan A, Chang TA, Tsai KC and Chen WJ: Spontaneous pneumothorax associated with ankylosing spondylitis. Rheumatology (Oxford). 44:1538–1541. 2005. View Article : Google Scholar : PubMed/NCBI
2	Boos N and Aebi M: Spinal Disorders: Fundamentals of Diagnosis and Treatment. Springer Science+Business Media B.V.; Dorhrecht, The Netherlands: 2008, View Article : Google Scholar
3	Noppen M: Spontaneous pneumothorax: Epidemiology, pathophysiology and cause. Eur Respir Rev. 19:217–219. 2010. View Article : Google Scholar : PubMed/NCBI
4	Sahn SA and Heffner JE: Spontaneous pneumothorax. N Engl J Med. 342:868–874. 2000. View Article : Google Scholar : PubMed/NCBI
5	Konopka JB, Watanabe SM, Singer JW, Collins SJ and Witte ON: Cell lines and clinical isolates derived from Ph1-positive chronic myelogenous leukemia patients express c-abl proteins with a common structural alteration. Proc Natl Acad Sci USA. 82:pp. 1810–1814. 1985, View Article : Google Scholar : PubMed/NCBI
6	Davis RL, Konopka JB and Witte ON: Activation of the c-abl oncogene by viral transduction or chromosomal translocation generates altered c-abl proteins with similar in vitro kinase properties. Mol Cell Biol. 5:204–213. 1985. View Article : Google Scholar : PubMed/NCBI
7	Preston-Martin S, Thomas DC, Yu MC and Henderson BE: Diagnostic radiography as a risk factor for chronic myeloid and monocytic leukaemia (CML). Br J Cancer. 59:639–644. 1989. View Article : Google Scholar : PubMed/NCBI
8	Penfold JB and Rhys-Lewis RD: Leukaemia, amyloidosis, and renal vein thrombosis in irradiated ankylosing spondylitis. Br Med J. 2:1034–1036. 1957. View Article : Google Scholar : PubMed/NCBI
9	Court-Brown WM and Doll R: Leukaemia and aplastic anaemia in patients irradiated for ankylosing spondylitis. 1957. J Radiol Prot. 27:B15–B154. 2007. View Article : Google Scholar : PubMed/NCBI
10	Ju FH, Gong XB, Jiang LB, Hong HH, Yang JC, Xu TZ, Chen YU and Wang Z: Chronic myeloid leukaemia following repeated exposure to chest radiography and computed tomography in a patient with pneumothorax: A case report and literature review. Oncol Lett. 11:2398–2402. 2016.PubMed/NCBI
11	van der Linden S, Valkenburg HA and Cats A: Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 27:361–368. 1984. View Article : Google Scholar : PubMed/NCBI
12	Rosenow E, Strimlan CV, Muhm JR and Ferguson RH: Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc. 52:641–649. 1977.PubMed/NCBI
13	Lawrence RC, Hochberg MC, Kelsey JL, McDuffie FC, Medsger TA Jr, Felts WR and Shulman LE: Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol. 16:427–441. 1989.PubMed/NCBI
14	Ersoy E, Akgol G and Ozgocmen S: Bilateral spontaneous pneumothorax in a patient with longstanding ankylosing spondylitis. Acta Reumatol Port. 39:353–354. 2014.PubMed/NCBI
15	Wang CT, Tsen JC, Lin HJ and Cheng HH: Bilateral spontaneous pneumothorax in a patient with ankylosing spondylitis. Eur J Emerg Med. 14:123–124. 2007. View Article : Google Scholar : PubMed/NCBI
16	Bhardwaj H, Bhardwaj B and Youness HA: A case of spontaneous pneumothorax following radiation therapy for non-small cell lung cancer. Lung India. 30:360–362. 2013. View Article : Google Scholar : PubMed/NCBI
17	Senel S, Kaya E, Aydogdu I, Erkurt MA and Kuku I: Rheumatic diseases and chronic myelogenous leukemia, presentation of four cases and review of the literature. Rheumatol Int. 26:857–861. 2006. View Article : Google Scholar : PubMed/NCBI
18	Sacchi S, Kantarjian H, O'Brien S, Cohen PR, Pierce S and Talpaz M: Immune-mediated and unusual complications during interferon alfa therapy in chronic myelogenous leukemia. J Clin Oncol. 13:2401–2407. 1995. View Article : Google Scholar : PubMed/NCBI
19	Linet MS, Slovis TL, Miller DL, Kleinerman R, Lee C, Rajaraman P and de Gonzalez Berrington A: Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin. 62:75–100. 2012. View Article : Google Scholar : PubMed/NCBI
20	Ben Abdelghani K, El Menaa M, Ben Abdelghani K, Souabni L, Belhadj S, Chekili S, Laatar A and Zakraoui L: Chronic myeloid leukemia and ankylosing spondylitis. Tunis Med. 90:9012012.PubMed/NCBI
21	Thomas E, Brewster DH, Black RJ and Macfarlane GJ: Risk of malignancy among patients with rheumatic conditions. Int J Cancer. 88:497–502. 2000. View Article : Google Scholar : PubMed/NCBI
22	Ho HH and Chen JY: Ankylosing spondylitis: Chinese perspective, clinical phenotypes, and associated extra-articular systemic features. Curr Rheumatol Rep. 15:3442013. View Article : Google Scholar : PubMed/NCBI