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Case report
Unique case of atraumatic splenic rupture in a patient with chronic lymphocytic leukaemia with Richter’s transformation
  1. Swetha Paduri1,
  2. Nitish Singh Nandu1,
  3. Thomas Brucker2,
  4. Paul Roach3 and
  5. Mukta Pant-Purohit4
  1. 1Internal Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
  2. 2Department of Pathology and Laboratory, Anatomic and Clinical Pathologist, Medical Director of Flow Cytometry Laboratory,Medical Director, department of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
  3. 3General & Oncologic Surgery, Lovell FHCC Department of Surgery, North Chicago, Illinois, USA
  4. 4Hemtology/Oncology, Section Chief, Hemtology/Oncology Captain James A Lovell Federal Health Care Center, Assistant Professor, Rosalind Franklin University, North Chicago, Illinois, USA
  1. Correspondence to Dr Nitish Singh Nandu; Nitishsinghnandu{at}gmail.com

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.

  • haematology (incl blood transfusion)
  • oncology

https://doi.org/10.1136/bcr-2021-242193

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    Footnotes

    • Contributors SP has made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work. NSN revised critically for important intellectual content. PP gave final approval of the version to be published; TB has provided the pathological slides, histology slides and assistance in interpreting the slides. PR has performed the splenectomy and also assisted with case report writing. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.