Intracranial Hemorrhage in a Pediatric Patient with Chronic Myeloid Leukemia in Chronic Phase: A Case Report

Abstract

Chronic myeloid leukemia (CML) is an uncommon entity in pediatric patients. CML in chronic phase (CML-CP) has a relatively favorable outcome. Leukostasis occurs in 9.7% of patients with CML. One of the most serious leukostasis-related complications is intracranial hemorrhage (ICH). However, this is very rare in patients with CML-CP, and few early mortalities have been reported in CML patients with leukostasis. We report the case of a 14-year-old female patient with CML-CP who developed ICH 8 days after admission. A 14-year-old girl developed symptoms of fatigue and slight fever and was diagnosed with CML-CP. She was treated with imatinib and received low-molecular-weight heparin owing to coagulation abnormalities. However, 6 days later, she developed sensorineural hearing loss, which is a symptom of leukostasis. She received hydroxyurea to reduce her white blood cell (WBC) count, and her treatment was changed from imatinib to nilotinib. The WBC and platelet counts remained unchanged, blast counts did not increase, and mild coagulation abnormality persisted. Eight days after admission, she suddenly lost consciousness and experienced respiratory arrest. Cranial computed tomography revealed multiple ICH lesions and brain hernia. She received intensive care but was diagnosed with brain death by electroencephalography and died 14 days after hospitalization. ICH is very rare in patients with CML-CP; however, patients with leukostasis and coagulation abnormalities can develop severe hemorrhage, even in the chronic phase. Thus, it is necessary to accurately estimate the cause and provide appropriate treatment for these patients.

Sensorineural Hearing Loss in Juvenile CML: A Rare Case Report in Surabaya, Indonesia

“…20 The reported cases of SNHL as an initial manifestation in juvenile CML have also revealed high WBC concentrations of 167-733 × 10 9 /L. [17][18][19] In our case, the patient had an extremely high WBC count of 780.72 × 10 9 /L and splenomegaly Schuffner 5. These data suggest that, among the multifactorial pathogenesis of CML, 5,6,8,10,17,22 the most notable in our case was hyperleukocytosis.…”

“…25 Patients with a WBC count higher than 300 × 10 9 /L and a spleen size larger than 10 cm are more likely to develop leukostasis complications. 7,19,20 A previous 368 study on leukostasis in children and adolescents with CML reported a significantly higher median WBC concentration in leukostasis cases than in non-leukostasis cases: 458.5 × 10 9 /L versus 151.8 × 10 9 /L, respectively. 20 The reported cases of SNHL as an initial manifestation in juvenile CML have also revealed high WBC concentrations of 167-733 × 10 9 /L.…”

“…18 There have been only a few cases of juvenile CML in which SNHL was reported in previous studies. [16][17][18][19][20] Furthermore, acute myeloid leukemia (AML) causes more pronounced leukostasis than CML, acute lymphoblastic leukemia (ALL), and chronic lymphocyic leukemia (CLL) because blasts generally withstand deformation better than well-differentiated leukocytes. Furthermore, myeloblasts (the dominating cells in AML) are bigger than lymphoblasts (the dominating cells in ALL) and lymphocytes (the dominating cells in CLL).…”

“…20 Previous reports have demonstrated SNHL in adult patients with CML (aged 21-100 years), 3,[5][6][7][8][9][10][21][22][23] and only a few cases of SNHL in juvenile CML have been reported. [16][17][18][19][20]…”

Intracerebral hemorrhage as the first symptomatic manifestation of chronic myeloid leukemia (chronic phase): A case report and literature review

“…e authors attempted auditory evoked potentials (which the patient did not cooperate to perform) and performed an MRI brain that revealed bleeds in the right lower frontal area and the anterior thalamus. Similarly, Takahashi et al [17] diagnosed a CML-CP patient from blood work who presented with fever and fatigue. e patient received hydration therapy, allopurinol, and low molecular weight heparin after her admission, while imatinib was commenced when the diagnosis was confirmed.…”