Spontaneous Regression Of Blastic Plasmacytoid Dendritic Cell Neoplasm Following Sepsis By Serratia Marcescens: A Case Report And Literature Review
Suzuki, A., Abe, S., Koyama, K., Suzuki, S., Nagao, M., Kobayashi, M., Nomura, J., Tsutsumi, T., Takeda, T., Oka, Y., Shirota, Y., Takasawa, N., Kodera, T., Okitsu, Y., Takahashi, S., Ichinohasama, R., & Kameoka, J. (2021). Spontaneous Regression of Blastic Plasmacytoid Dendritic Cell Neoplasm Following Sepsis by Serratia marcescens: A Case Report and Literature Review. Internal medicine (Tokyo, Japan), 60(6), 927–933. https://doi.org/10.2169/internalmedicine.5820-20
View Original Source →Abstract
Spontaneous regression is rare in patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN). An 85-year-old man presented with pancytopenia and skin lesions, and the bone marrow exhibited 79.6% CD4+, CD56+, CD123+, and TCL-1+ abnormal cells, with a normal karyotype; he was thus diagnosed with BPDCN. While being followed without chemotherapy, he was admitted due to sepsis induced by Serratia marcescens, which was successfully treated with antibiotics. Notably, his blood cell counts improved, and the skin lesions disappeared. To our knowledge, this is the first reported case of spontaneous regression of BPDCN with a decrease in tumor cells in the bone marrow following sepsis.
Case Details
Disease Location
Bone marrow, blood
Personal Characteristics
85-year-old man, history of cancer of the appendix, which had undergone surgical resection six years previously without chemotherapy or radiotherapy. History of aortic arch aneurysm, for which stent-graft treatment had been performed seven years previously.
Clinical Characteristics
Shortness of breath. Physical examination: two skin nodules on the trunk. Signs of anemia in the palpebral conjunctivae. Blood cell counts showed severe pancytopenia, severe anemia. Elevated serum creatinine and soluble interleukin-2 receptor. Bone marrow aspirate showed hypercellular marrow with 79.6% small to medium-sized abnormal cells, with a high nucleus-to-cytoplasm ratio. Diagnosis of blastic plasmacytoid dendritic cell neoplasm (bpdcn) was made. He was only treated with red blood cell transfusions. 3 months later, the patient was admitted to the hospital because of a high fever, up to 40c, accompanied by chills and shivering. He was hemodynamically unstable. Physical examination revealed fine crackles in the lower parts of both lungs. Laboratory tests showed pancytopenia and anemia. Blood chemistry tests revealed increased levels of c-reactive protein, procalcitonin, and d-dimer. The patient was diagnosed with sepsis, which was later supported by positive cultures of serratia marcescens. He was treated with broad-spectrum antibiotics (tazobactam/piperacillin) combined with granulocyte-colony stimulating factor (g-csf). After remission, the disease relapsed.
Remission Characteristics
2 months later, bone marrow aspiration performed in september showed a decrease in abnormal cells, while the peripheral blood showed no abnormal cells.
Treatment & Mechanisms
Proposed Remission Mechanisms
Probably induced by sepsis
Clinical Treatment
Bone marrow aspiration, blood cell transfusion, pierpacillin/tazobactam, granulocyte-colony stimulating factor
Non-Clinical Treatment
None reported