A 55-year-old male presented to us in the Department of General Medicine at Mahatma Gandhi Hospital Jodhpur, India with complaint of pain and swelling of left thigh since 10 days. He denied of trauma in recent past. He had no sternal tenderness, purpurae, petechiae, and ecchymosis on his body. His family history was not significant in relation to haematological disease. He was not suffering from any chronic illness and had no addictions. On examination patient had swelling of the left thigh not extending beyond knee joint. The left mid thigh girth was 70 cm as compare to right that was 57 cm. The swelling was warm to touch, soft, boggy and tender to palpate. Fundoscopy was normal. His vital parameters were within normal limits. Lungs were bilaterally clear and cardiac auscultation was normal. Splenomegaly was found on palpation. Lymph nodes were not palpable. Laboratory investigations revealed a haemoglobin (Hb) of 5.7 g/dL, total leukocyte count (TLC) of 3,20,000/mm 3 , and Platelets were 12,24,000/mm 3 with PBF showing normocytic normochromic anaemia with leukocytosis and thrombocytosis with few myelocytes and metamylocyte. The Bone marrow examination showed hypercellular marrow (myeloid hyperplasia) with M:E ratio of 49:1 and 28% myelocytes, 3% myeloblast, 7% promyelocyte , 14% metamyelocyte, 42% neutrophils, and 2% basophils, suggestive of CML [ Table/
ABSTRACTSpontaneous soft tissue haematomas are rarely found in haematological malignancies. Chronic myeloid leukemia (CML) is a myeloproliferative disorder which rarely present with thrombo-haemorrhagic phenomenon. It is a malignant clonal disorder of pleuripotent stem cells that results in increase in myeloid, erythroid and platelets cells in peripheral blood and marked myeloid hyperplasia in bone marrow. It is characterized by the presence of Philadelphia chromosome (Ph) with BCR -ABL 1 fusion gene. This gene is responsible for the formation of 210 KDa chimeric proteins with enhanced tyrosine kinase activity which leads to the abnormal bone marrow cell proliferation and to the clinical and morphologic manifestations of leukemia. Cutaneous and mucous membrane bleeding is common in CML whereas bleeding in deep soft tissue is rarely found because of qualitative and quantitative platelet abnormalities. Here, we report a case of CML (BCR-ABL rearrangement positive) who presented with large haematoma in the anterior as well as posterior compartment of left thigh and treated successfully with hydroxyurea and imatinib.on hydroxyurea, imatinib and allopurinol. On 15 th day of starting imatinib, and hydroxyurea, repeat CBC revealed Hb 8.6 g/dL, TLC 56,000/mm 3 and platelets were 4,50,000/mm 3 . Coagulation profile became normal. Haematoma managed conservatively and resolved completely in repeat MRI after 20 days and he became asymptomatic with normal hematologic parameters. He was discharged on imatinib 400mg with advice for further follow up.