Unique case of atraumatic splenic rupture in a patient with chronic lymphocytic leukaemia with Richter’s transformation

Abstract

Though rare, atraumatic rupture of the spleen can be a complication in certain leukaemias and lymphomas. We present a unique case of atraumatic rupture of the spleen in a patient with chronic lymphocytic leukaemia. The patient presented to the emergency department with abdominal pain; he had been on ibrutinib therapy but stopped taking the medication abruptly 6 days prior. On evaluation, he was found to have a ruptured spleen with a haemoperitoneum. Pathology of the excised spleen showed infiltration of the spleen with hyperproliferated CD5+ intermediate-to-large cells, consistent with B-cell lymphoma and favouring Richter’s transformation. There are only a few available reports of patients with similar presentations identified in our literature review.

Chronic lymphocytic leukemia, a rare cause of spontaneous rupture of the spleen

“…spontaneous spleen rupture (SRS) was first described by Rokitansky in 1861 and mentioned in many cases since [1] . The term “pathological splenic rupture” was introduced in 1928 by Lange to define the non-traumatic splenic rupture that occurs in a diseased spleen [2] .…”

“…It is an unusual complication of malignant hematological disorders. According to the literature only few incidences of spontaneous splenic rupture are caused by chronic lymphocytic leukemia [1] .…”