Spontaneous splenic rupture in a patient with acute promyelocytic leukaemia during induction chemotherapy

Abstract

Background. Acute promyelocytic leukaemia (APL) is a subtype of acute myeloid leukaemia with high curability rates. However, it is often accompanied by severe coagulopathy and bleeding risk and thus represents a potentially fatal haematological emergency requiring immediate treatment. Spontaneous splenic rupture is a rare event in all haematological malignancies. Only two clinical cases have been described so far in a setting of APL. Case report. We report a patient with APL without preceding splenomegaly who underwent urgent splenectomy for spontaneously occurring splenic rupture during induction chemotherapy. After surgery the patient completed induction chemotherapy and achieved complete remission. Conclusion. This is the second case of spontaneous splenic rupture without preceding splenomegaly in a patient with APL during induction chemotherapy described so far. Our case demonstrates that emergent splenectomy can be lifesaving even in the unfavourable condition of patient with severe immune deficiency.

Spontaneous splenic rupture in a patient with chronic granulocytic leukemia

“…10,11 In hemodynamically unstable patients, emergency splenectomy is indicated as a rescue measure. 12,13…”

Unexpected death involving the spleen – an overview

“…Haematological malignancies, particularly non-Hodgkin lymphoma, acute lymphoblastic leukaemia, acute myeloid leukaemia (Figure 3(B)) and chronic myeloid leukaemia, constitute the principal cause of atraumatic rupture of the spleen. 43,44 Hynes et al suggested that one of three processes may be involved: (1) congestion of the spleen by blast cells; (2) abnormal coagulation resulting in intrasplenic and subcapsular haemorrhage; or (3) splenic infarction. 45 Other haematological cancers associated with splenic rupture include Hodgkin lymphoma (Figure 3(C) and (D)), adult T-cell leukaemia, 46 chronic lymphoid leukaemia, 47 mantle cell leukaemia, 48,49 and multiple myeloma.…”

“…50 In cases of multiple myeloma, splenomegaly may be associated with amyloid accumulation within the spleen. 51 Rupture may, however, occur with normal-sized, though compromised, spleens, 44,52 sometimes associated with unusual infections such as tuberculosis and fungi. 52,53 On occasion therapies such as granulocyte-colony stimulating factor for neutropenia associated with myelodysplastic syndrome may cause splenic enlargement and predispose to rupture.…”