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Case Reports in Hematology
Volume 2013 (2013), Article ID 802376, 3 pages
http://dx.doi.org/10.1155/2013/802376
Case Report

Spontaneous Retroperitoneal Hemorrhage in a Patient with Prolymphocytic Transformation of Chronic Lymphocytic Leukemia

1Department of Medicine, Western University, London, ON, Canada
2Division of Hematology, Department of Medicine, Western University, London Health Sciences Centre, Room E6-219, Victoria Hospital, 800 Commissioners Road East, P.O. Box 5010, London, ON, Canada N6A 4G5
3Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
4Department of Pathology, Western University, London, ON, Canada

Received 17 June 2013; Accepted 18 July 2013

Academic Editors: T. Sonoki and R. Tiu

Copyright © 2013 Gwynivere A. Davies et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Prolymphocytic transformation of chronic lymphocytic leukemia is a rare but recognized entity. We present the case of a 76-year-old gentleman with a previous diagnosis of chronic lymphocytic leukemia who presented with fatigue, fever, and a white blood cell count of 500 000 with prolymphocytes on peripheral blood examination. Chlorambucil and dexamethasone were initiated. He developed progressive anemia during his admission with no clear cause on initial CT examination. Bilateral hip pain began several days later and he was unfortunately diagnosed with a large spontaneous retroperitoneal hemorrhage postmortem. This condition is rare and generally occurs in those receiving therapeutic anticoagulation or dialysis, with known bleeding disorders or vascular malformation, none of which were present in our patient. Pathology revealed marked leukemoid engorgement of the vessels of many organs with prolymphocytes. We discuss the potential etiologies and relationships between these critical diagnoses.