Polyserositis as an Initial Manifestation of Chronic Lymphocytic Lymphoma

Abstract

Chronic lymphocytic lymphoma (CLL) is a lymphoproliferative malignancy characterized by the generation and accumulation of CD5+ monoclonal B-cell lymphocytes, which are physically mature lymphocytes with aberrant immunological activity. The common presenting features are lymphadenopathy and leukocytosis. Because of its asymptomatic and indolent appearance, CLL requires a high index of suspicion to be diagnosed. Our patient presented with unusual symptoms of malignant polyserositis without substantial lymphadenopathy or hepatosplenomegaly. Ascitic fluid cytology and flow cytometry were done to confirm the diagnosis. The patient was staged modified Rai 0 and Binet A and categorized as low-risk status. Treatment is usually advised at Rai stage II and Binet stage B and higher. Although there is no mention of ascites or pleural effusion in the staging disease or deciding therapy, malignant polyserositis carries a poor prognosis and the decision to treat should be individualized. Our patient was offered chemotherapy but the patient denied it. He was on regular follow-ups receiving palliative therapy.