Multiple Faces of Chronic Lymphocytic Leukaemia: A Patient with Renal, Cardiac, and Skeletal Complications

Abstract

We describe a patient who had chronic lymphocytic leukaemia (CLL) Binet stage A at presentation with further evidence of disease at multiple sites but who initially required no treatment. However, several years later, her peripheral blood lymphocyte count started to increase, and soon after that she suffered an acute myocardial infarct (in the absence of coronary atheroma) together with proteinuric renal failure due to membranoproliferative glomerulonephritis. Her renal function improved markedly following anti-CLL chemotherapy. We postulate that her cardiac and renal disease were both complications of her CLL. In patients with CLL who develop new clinical signs or symptoms (even if apparently unrelated), consideration should be given as to whether these may be disease complications as this may serve as an indication to commence anti-CLL therapy; close liaison between different specialties is vital.

A case of bone lesion in a patient with relapsed chronic lymphocytic leukemia and review of the literature

“…In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 and in rare cases, fractures were localized to the skull or facial bones. 17 , 22 , 23 Multiple fractures were reported in 8 cases.…”

“…[7][8][9] Some cases in literature have already described the presence of lytic lesions in patients affected by CLL, and one of them was previously described by our group. 10 In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved, [10][11][12][13][14][15][16][17][18][19][20][21] and in rare cases, fractures were localized to the skull or facial bones. 17,22,23 Multiple fractures were reported in 8 cases.…”

A case of bone lesion in a patient with relapsed chronic lymphocytic leukemia and review of the literature

“…[7][8][9] Some cases in literature have already described the presence of lytic lesions in patients affected by CLL, and one of them was previously described by our group. 10 In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved [10][11][12][13][14][15][16][17][18][19][20][21] and in rare cases fractures were localized to the skull or facial bones. 17,22,23 Multiple fractures were reported in 8 cases.…”

Cardiac Involvement in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

“…The presence of acute coronary syndrome, secondary to cardiac infiltration and coronary occlusion of CLL cells, has been recently reported in four patients ( Table 2 ) [ 30 , 31 , 32 , 33 ]. Bennet et al present the case of a patient with a history of CLL who developed clinical and ECG symptoms of coronary ischemia [ 30 ].…”

“…Again, microscopic evaluation during autopsy revealed a thick rim of lymphocytes in the adventitia of the coronary arteries and focal prominent clusters of lymphocytes in the atherosclerotic plaques. Htet et al [ 33 ] report the case of a patient presenting with acute coronary symptoms and a troponin rise. Magnetic resonance imaging (MRI) and echocardiogram revealed full thickness infarction and hypokinesia secondary to a rising peripheral lymphocyte count in peripheral blood.…”