A Case Report of B-cell Prolymphocytic Leukemia Presenting with Atraumatic Splenic Rupture

Abstract

The patient was a 63-year-old man with a 2-week history of left nephelopsia and diplopia; he had been diagnosed as having optic neuritis based on CT and MRI findings and been prescribed prednisolone (5 mg/day). He had developed sudden abdominal pain and was transported to the hospital in an ambulance. He was in a state of shock, and abdominal CT revealed extensive high-concentration ascites, indicative of a hematoma, and bleeding around the spleen. Laboratory examination revealed severe anemia and an abnormally elevated total leukocyte count, and the patient was diagnosed as having splenic rupture due to hematologic malignancy; immediate surgery was performed. A large amount of hemorrhagic ascites was found in the abdominal cavity, and splenectomy was performed to remove the ruptured spleen. The leukocyte count gradually increased postoperatively, with a peripheral smear examination revealing a high proportion of blast cells. On postoperative day 7, the patient was diagnosed as having B-cell prolymphocytic leukemia based on the histopathological findings, and was transferred to a specialized institution on postoperative day 8. Chemotherapy with rituximab was initiated, but brain infiltration occurred. Radiotherapy was also ineffective, and the patient died 50 days after the hospital transfer (58 days following the onset of splenic rupture). A definitive diagnosis of B-cell prolymphocytic leukemia was made based on detailed histopathological examination. In cases diagnosed as having spontaneous splenic rupture, splenectomy must be performed to detect the cause of the rupture at the earliest, considering the possibility of hematological malignancy, which carries a bad prognosis.