title: [Chronicle myeloid leukemia and hiperviscosity syndrome: case report].
abstract: OBJECTIVE
  Hyperleukocytosis (> 100 x 10(9)/L) is an uncommon presentation of chronic leukemias and it can present clinical symptoms of hyperviscosity syndrome. Hearing loss and blindness rarely occurs in patients with leukemia; however, it can be strong association with hyper-viscosity syndrome. The purpose of this paper is to report a case of acute hearing loss as the initial manifestation of acute leukemia and hyper-viscosity syndrome and also mainly aspects of the intensive care treatment.
  
  
  METHODS
  A 41 year-old, male patient, who has been complaining about dizziness for six months with no response to symptomatic medications, was admitted to the emergency department with acute hearing loss. The physical examination was normal except for a bilateral hearing loss without an apparent cause. Laboratory exams showed total leukocyte: 645.000 with 66.4% blasts, hemoglobin: 7.0, hematocrit: 20.5, urea: 94, creatinine: 1.59, K: 5.6, Na: 138, INR: 1.38, TTPa: 0.89, troponin lower than 0.2, CK: 218, CKMB: 50, uric acid: 11.1. After a first hypothesis of leukemia with a high risk of hyper-viscosity complications, the patient was admitted to the Intensive Care Unit for monitoring and treatment. A bone marrow biopsy was performed and than started hidratation, hydroxyurea, allopurinol, dexamethasone. According to hematologists the patient had a chronic myeloid leukemia. Leukopheresis was performed one week after admission when total blood leukocytes were around 488.000. Ten days after the procedure the patient had no improvement of the hearing loss but total leukocytes were 10.100. He was discharge to the ward and 2 weeks later went home to continue ambulatory treatment.
  
  
  CONCLUSIONS
  The frequency of sensitive manifestations in patients with leukemia include not only visual and hearing loss but also many others manifestations such as conductive vertigo, facial palsy and infections. Hyperviscosity syndrome due to hyperleukocytosis is also a possible cause of sensorial loss, but the syndrome is often dependent on leukocyte counts greater than (>100 x 10(9)/L).This case is a representative of rare cases in which acute sensorineural hearing loss occurred as the initial manifestation of hyper-viscosity syndrome due to leukemia.
authors.affiliation: EPM, UNIFESP.
authors.forename: Juliana
authors.initials: J
authors.lastname: Amâncio
authors.affiliation: EPM, UNIFESP.
authors.forename: Gisele
authors.initials: G
authors.lastname: Scuro
authors.affiliation: EPM, UNIFESP.
authors.forename: Fernanda Martins
authors.initials: FM
authors.lastname: Gazoni
authors.affiliation: EPM, UNIFESP.
authors.forename: Hélio Penna
authors.initials: HP
authors.lastname: Guimarães
authors.affiliation: AMB, AMIB.
authors.forename: Letícia Sandre
authors.initials: LS
authors.lastname: Vendrame
authors.affiliation: EPM, UNIFESP.
authors.forename: Renato Delascio
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: EPM, UNIFESP.
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Lopes