Blastic Phase of CML with Microfilaria: A Rare Case Report

Abstract

A 37-year-old male, diagnosed case of CML on Imatinib mesylate, presented with low grade fever, weight loss and abdominal distension for one month. Physical examination revealed massive splenomegaly and hepatomegaly, however there was no lymphadenopathy.His hemoglobin was 10.5 g/dl, total leucocyte count was 52.31 x 109 / L with platelet count of 30 x 109/L. Differential leucocyte count on peripheral smear showed 21% blasts [Table/ Fig-1], 30% polymorphs, 16% lymphocytes, 1% myelocyte, 1%metamyelocyte, 30%monocytoid cells and 1% eosinophils. Blasts were large with high N: C ratio, pale basophilic cytoplasm, some of them showed 1-4 nucleoli. In addition, occasional microfilaria was also seen [Table/ Fig-2]. They were morphologically characterized as the microfilaria of W. bancrofti, as they were sheathed and lacked terminal nuclei.Bone marrow aspirate smears were diluted with blood. However, they showed blasts and monocytoid cells accounting for 25% and 15% of marrow nucleated cells respectively .The blasts had same Pathology SectionBlastic Phase of CML with Microfilaria: A Rare Case Report aBstRaCt Filariasis is a major public health concern in tropical and subtropical countries including India. There have been very few case reports of incidental filariasis in the bone marrow aspirate smears in patients with hematological malignancies. We present a case of blastic phase of chronic myeloid leukemia (CML) with associated filariasis with monocytosis. Such an association, to the best of our knowledge, is hitherto unreported. Moreover, eosinophilia was not a feature in our case.A 37-year-old male, diagnosed case of CML, presented with low grade fever, weight loss and abdominal distension for one month. Physical examination revealed massive splenomegaly and hepatomegaly. However, there was no lymphadenopathy. His hemoglobin was 10.5 g/dl, total leukocyte count was 52.31x 109 / L with platelet count of 30x 109/L .Differential leukocyte count on peripheral smear showed 21% blasts, 30% polymorphs, 16% lymphocytes, 1% myelocyte, 1%metamyelocyte, 30%monocytoid cells and 1% eosinophils.Bone marrow aspirate smears were diluted with peripheral blood and showed blasts and monocytoid cells constituting 25% and 15% of marrow nucleated cells respectively. In addition, occasional microfilaria of Wuchereria bancrofti were also seen both in the peripheral blood and aspirate smears.Based on the above findings, a diagnosis of blastic phase of CML with monocytosis with microfilaria of W.bancrofti.Hence this was an unusual case of CML blastic phase which was associated with filariasis. Moreover, inspite of having filariasis and CML, patient lacked eosinophilia and instead showed monocytosis, which is hitherto unreported.

Filarial huge splenomegaly dramatically regressed by anti-filarial medication: A rare clinical scenario

“…Uzma Zafar et al (8) reported an interesting case of low back pain and destruction of first lumbar vertebra by the microfilariae residing in the bone marrow. There were several case reports of huge splenomegaly in leukaemia patients with incidental detection of bone marrow microfilariae (9)(10)(11). Possible explanation for splenomegaly in those cases were due to leukaemia not filariasis because spleen is usually not involved in filariasis except in some experimentally infected animals although Schuurkamp GJ et al (14) showed occurrence of filarial splenomegaly in their articles.…”

Filariasis presenting with bicytopenia, progressive splenomegaly and acute renal failure: An unusual case report

“…Splenomegaly is an uncommon presentation. Where leukaemia is present, microfilariae may be an incidental and co-existing finding, 5–7 However in those cases, splenomegaly was due to the leukaemic process.…”

“…Prior reports of filariasis described on bone marrow aspirate have often been associated with underlying leukemia, 5–7 and sometimes with non-neoplastic progressive splenomegaly and anaemia, 8 resulting from inadequate management of peripheral blood eosinophilia.…”