Hearing Loss and CLL: a Rare Complication of Leukostasis

In chronic lymphocytic leukemia (CLL), hyperleukocytosis has a prevalence of 20-40%, but leukostasis is extremely rare. In this case, a 53-year-old male with no known medical history presented to the emergency department with acute bilateral hearing loss, shortness of breath, diffuse lymphadenopathy, weight loss, and an abdominal mass, and was found to have hyperleukocytosis (WBC: 1075.5 bil/L), anemia (Hb: 2.2 g/dL), and thrombocytopenia (Platelets: 33 bil/L). Flow cytometry and lymph node biopsy found chronic lymphocytic leukemia with a 13q14.3 deletion, and subsequently started on venetoclax resulting in resolution of the leukocytosis and thrombocytopenia. Persistent hearing loss led to attempting oral and intratympanic corticosteroids, which also failed to restore hearing. No lesions were found in the bilateral internal auditory canals on MRI. Unlike previous cases of hearing loss in CLL-related leukostasis, this patient's hearing loss did not resolve with CLL resolution, which suggests that increased viscosity versus other unidentified etiologies are the cause. Further studies need to be conducted in this subset of patients to better understand and combat the mechanisms behind CLL-related leukostasis hearing loss.