Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hematol. Dec 29, 2023; 10(4): 42-47
Published online Dec 29, 2023. doi: 10.5315/wjh.v10.i4.42
Unusual presentation of extramedullary blast crisis in chronic myeloid leukemia: A case report
Rashmi Mishra, Sandeep Garg, Praveen Bharti, Deepak Ranjan Malla, Ishan Rohatgi, Sachin Gautam
Rashmi Mishra, Sandeep Garg, Praveen Bharti, Deepak Ranjan Malla, Ishan Rohatgi, Department of General Medicine, Maulana Azad Medical College, New Delhi 110002, Delhi, India
Sachin Gautam, Department of Internal Medicine, Maulana Azad Medical College, New Delhi 110002, Delhi, India
Author contributions: Mishra R, Garg S and Bharti P contributed to the evaluation, diagnosis and management of the patient; Malla DR and Gautam S carried out the necessary procedures for the diagnosis; Rohatgi I analyzed the data, compiled the necessary reviews and wrote the manuscript; all authors read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rashmi Mishra, MD, Assistant Professor, Doctor, Department of General Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, Delhi, India. rashmi.virgo02@gmail.com
Received: October 3, 2023
Peer-review started: October 3, 2023
First decision: November 2, 2023
Revised: November 15, 2023
Accepted: December 19, 2023
Article in press: December 19, 2023
Published online: December 29, 2023
Abstract
BACKGROUND

Extramedullary blast crisis in chronic myeloid leukemia (CML) is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow. Malignant infiltration of the serosal membranes should be considered in cases where CML presents with ascites or pleural effusion.

CASE SUMMARY

A 23-year-old female with CML presented with progressively worsening ascites and pleural effusion despite first-line tyrosine kinase inhibitor treatment. Her blood work indicated leukocytosis with myelocyte bulge and 2% blasts. Analysis of the patient’s bone marrow confirmed the chronic phase of CML. Abdominal ultrasound revealed hepatosplenomegaly with ascites. The fluid investigation of both ascites and pleural effusion revealed a predominance of neutrophils with exudate. However, no acid-fast bacilli or growth was observed after culturing. Although hydroxyurea reduced cell counts, there was no observed effect on ascites or pleural effusion. Repeat investigation of the ascitic and pleural fluid revealed a polymorphous myeloid cell population consisting of myelocytes, metamyelocytes, band forms, neutrophils and a few myeloblasts. Extramedullary blast crisis was suspected, and mutation analysis was performed. We switched the patient to dasatinib. The patient’s symptoms were relieved, and ascites and pleural effusion diminished.

CONCLUSION

Serosal membrane involvement in CML is extremely rare. In this case, the patient responded well to dasatinib treatment.

Keywords: Chronic myeloid leukemia, Extramedullary blast crisis, Serosal infiltration, Ascites, Pleural effusion, Case report

Core Tip: Extramedullary blast crises exhibit diverse presentations, underscoring the importance of awareness of possible sites of occurrence. In cases of chronic myeloid leukemia with ascites or pleural effusion, it is essential to consider the possibility of malignant infiltration of serosal membranes as a potential diagnosis. Recognizing these signs early can lead to timely intervention and management.