A Case of Pathologic Splenic Rupture as the Initial Manifestation of Acute Myeloid Leukemia M2

Abstract

A pathologic splenic rupture refers to a rupture without trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare. In this study, we described a rare case of acute myeloid leukemia presenting principally as an acute abdomen due to a pathologic splenic rupture in a 35-year old male patient. We can assert that a pathologic splenic rupture in hematologic diseases is a potentially life-threatening complication, which necessitates immediate operative intervention. Any such patient complaining about left upper abdominal tenderness should be closely observed, and further diagnostic investigations (ultrasonograph of the abdomen, abdominal CT scan) should be initiated in order to rule out a splenic rupture. The oncologist should be aware of this rare initial presentation of acute myeloid leukemia (AML) M2, as the condition generally necessitates a prompt splenectomy.

Spontaneous splenic rupture in an acute leukemia patient with splenic tuberculosis: A case report

“…Spontaneous splenic rupture, also referred to as atraumatic splenic rupture, is an uncommon serious complication of acute leukemia, with very few reported cases since Rokitansky first described spontaneous rupture of the spleen in a patient with leukemia in 1861 (1)(2)(3)(4)(5)(6)(7). Although the precise occurrence of spontaneous splenic rupture is not known, its actual morbidity may be higher due to the difficulty of diagnosis in the past.…”

Spontaneous splenic rupture during induction chemotherapy for acute myeloid leukemia

“…While undergoing induction chemotherapy, she suffered a SSR leading to a massive hemoperitoneum. SSR, also referred to as atraumatic splenic rupture, is a rare life-threating event that requires prompt diagnosis and management [5]. SSR presents universally with severe abdominal pain, distension, left shoulder pain due to diaphragmatic irritation (Kehr’s sign) and hemodynamic instability due to hemorrhage [1,4].…”

“…Acute leukemias accounted for 34-40% of cases among patients with hematologic malignancies [2-4,6]. SSR as the presenting symptom in patients with AML has been rarely reported [2,5,6,8,9]. Possible mechanisms for this phenomenon include distension of the spleen due to leukemic infiltrates especially in the capsule; splenic infarcts resulting in capsular hemorrhage; and AML-associated coagulopathy [5,6,10].…”

“…SSR as the presenting symptom in patients with AML has been rarely reported [2,5,6,8,9]. Possible mechanisms for this phenomenon include distension of the spleen due to leukemic infiltrates especially in the capsule; splenic infarcts resulting in capsular hemorrhage; and AML-associated coagulopathy [5,6,10]. SSR in AML after initiation of chemotherapy is even less reported [2,11,12], including one report of fatal SSR in a patient with AML receiving induction chemotherapy with recombinant human granulocyte-macrophage colony-stimulating factor [11] and another patient with acute promyelocytic leukemia who developed SSR on day 2 of all- trans -retinoic-acid and idarubicin [12].…”

“…SSR in AML after initiation of chemotherapy is even less reported [2,11,12], including one report of fatal SSR in a patient with AML receiving induction chemotherapy with recombinant human granulocyte-macrophage colony-stimulating factor [11] and another patient with acute promyelocytic leukemia who developed SSR on day 2 of all- trans -retinoic-acid and idarubicin [12]. Reports suggest that male gender, age > 20 years, presence of splenomegaly and use of cytoreductive therapy are associated with an increased risk of SSR in patients with hematologic malignancies [3-5]. However, splenomegaly is not a prerequisite for SSR, as several autopsies have demonstrated normal sized spleens [2,6].…”