title: Spontaneous retroperitoneal hemorrhage in a patient with prolymphocytic transformation of chronic lymphocytic leukemia.
abstract: Prolymphocytic transformation of chronic lymphocytic leukemia is a rare but recognized entity. We present the case of a 76-year-old gentleman with a previous diagnosis of chronic lymphocytic leukemia who presented with fatigue, fever, and a white blood cell count of 500 000 with prolymphocytes on peripheral blood examination. Chlorambucil and dexamethasone were initiated. He developed progressive anemia during his admission with no clear cause on initial CT examination. Bilateral hip pain began several days later and he was unfortunately diagnosed with a large spontaneous retroperitoneal hemorrhage postmortem. This condition is rare and generally occurs in those receiving therapeutic anticoagulation or dialysis, with known bleeding disorders or vascular malformation, none of which were present in our patient. Pathology revealed marked leukemoid engorgement of the vessels of many organs with prolymphocytes. We discuss the potential etiologies and relationships between these critical diagnoses.
authors.affiliation: Department of Medicine, Western University, London, ON, Canada.
authors.forename: Gwynivere A
authors.initials: GA
authors.lastname: Davies
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lazo-Langner
authors.forename: Michael
authors.initials: M
authors.lastname: Shkrum
authors.forename: Leonard
authors.initials: L
authors.lastname: Minuk
references.citation: J Emerg Med. 2012 Aug;43(2):e157-61
references.pmid: 21911282
references.citation: Am J Emerg Med. 1995 Jan;13(1):107-10
references.pmid: 7832933
references.citation: Med Oncol. 2007;24(1):17-32
references.pmid: 17673808
references.citation: Abdom Imaging. 1999 May-Jun;24(3):246-9
references.pmid: 10227887
references.citation: Am J Hematol. 2003 Apr;72(4):243-7
references.pmid: 12666134
references.citation: Blood. 2008 Jun 15;111(12):5446-56
references.pmid: 18216293
references.citation: Radiographics. 1995 Nov;15(6):1285-97
references.pmid: 8577956
references.citation: Int J Clin Pract. 2008 Oct;62(10):1604-13
references.pmid: 17949429
references.citation: Am J Surg. 2005 Mar;189(3):345-7
references.pmid: 15792766
references.citation: Ann Hematol. 1993 Dec;67(6):309-11
references.pmid: 8280815
references.citation: Leukemia. 1999 Aug;13(8):1294
references.pmid: 10450761
references.citation: Br J Haematol. 1986 Jun;63(2):377-87
references.pmid: 3487341
references.citation: Clin Appl Thromb Hemost. 2011 Feb;17(1):88-93
references.pmid: 20699254
references.citation: Haemophilia. 2005 Sep;11(5):535-8
references.pmid: 16128899