Spontaneous splenic rupture as the first manifestation of chronic myeloid leukemia: A case report.

Abstract

Background: Spontaneous splenic rupture (SSR) is an uncommon life-threatening complication of chronic myeloid leukemia (CML); however, it rarely occurs as the initial presentation of the disease. A contrast-enhanced computed tomography (CT) scan is the preferred method for confirming the diagnosis. The definitive treatment is radical splenectomy.

Case presentation: We report the case of a 37-year-old previously healthy man who presented to the Emergency Department with severe, vague abdominal pain and nausea of one day's duration. On physical examination, he had epigastric tenderness and palpable splenomegaly, while his vital signs were within the normal limits. Contrast-enhanced CT revealed massive splenomegaly and splenic rupture with active bleeding. Subsequently, the patient became hemodynamically unstable and required an urgent total splenectomy. Molecular cytogenetic tests showed abnormalities consistent with CML. The patient's condition gradually improved, and he was discharged home on the 10th postoperative day.

Discussion: SSR typically occurs in patients with preexisting hematologic disorders or constitutional symptoms. This case is unique because the patient, who had no history of trauma, constitutional symptoms, or a known hematologic disorder, presented with massive splenomegaly and extremely elevated leukocytosis and was found to have undiagnosed CML. The patient's massive splenomegaly and abrupt splenic rupture highlight that SSR can occur even in the absence of classic B symptoms, posing significant diagnostic and management challenges. Timely multidisciplinary intervention is crucial, and thorough post-splenectomy care is essential.

Conclusion: SSR as the initial manifestation of CML is an uncommon and unexpected clinical presentation. This case demonstrates that extreme leukocytosis and massive splenomegaly can precipitate splenic rupture in the absence of prodromal symptoms. Timely surgical intervention, comprehensive post-splenectomy care, and the prompt initiation of targeted therapy are indispensable for achieving optimal clinical outcomes, as demonstrated in our patient.