Impending splenic rupture as indicator of atypical chronic lymphocytic leukemia: A case report from Saudi Arabia

• Published in: International journal of surgery case reports 2023-09, Vol.110, p.108748, Article 108748
• Main Authors: Al-Ansari, Rehab Y., Al-Rayes, Hezab, Abdalla, Leena Mohamed, Alshehri, Abdulaziz Abdullah, Woodman, Alexander
• Format: Article
• Language: English
• Subjects: Case Report; Chronic lymphocytic leukemia; Mantel lymphoma; Non-Hodgkin lymphoma; Splenic marginal zone lymphoma; Splenic rupture
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108748

Chronic lymphocytic leukemia (CLL) is one of the hematological malignancies in which the bone marrow overproduces mature, dysfunctional lymphocytes. Affected lymphocytic cells can affect the lymph nodes, spleen, liver, bone marrow, and rarely other organs. Spontaneous rupture of the spleen is a rare health condition, with a few cases caused by CLL. Since the preliminary presentation of either impending or real splenic rupture is unusual and requires recording and reporting, this case report was developed. A 55-year-old male patient presented with a significant weight loss of 20 kg, loss of appetite, fatigue, abdominal pain, and early satiety. Clinical examination revealed massive splenomegaly 22 cm below the costal margin, otherwise unremarkable on systemic examination. The size and dimensions of the spleen were confirmed by computed tomography of the body. The patient underwent a bone marrow biopsy, which was suggestive of atypical CLL. Due to the rapid progression of the size of the spleen and the pattern of impending rupture of the spleen, an emergency splenectomy was performed, and the histopathological report confirmed low-grade B-cell non-Hodgkin's lymphoma, mostly typical of CLL. Given the rarity of cases, continuous data recording and reporting is required to enrich the scientific literature and share experiences from case to case. This will create a complete picture of this health condition across diverse regions and countries. •Spontaneous rupture of the spleen is a rare health condition, with a few cases caused by CLL.•Splenectomy for impending rupture due to CLL could slowed the disease progression and reduced the needs for chemotherapy.•The mechanism of splenic rupture in CLL is due to infiltration of the leukemic cells, infarction or subcapsular hemorrhage.