A Case of Spontaneous Splenic Rupture as an Initial Presentation of Possible Acute Myeloid Leukemia or Chronic Myelomonocytic Leukemia in an Elderly Patient

Introduction and Deviation from the Expected: Spontaneous (atraumatic) splenic rupture is an extremely rare complication of leukemia that has been previously described however very few cases have ever been reported as an initial presentation of acute myeloid leukemia (AML) or chronic myelomonocytic leukemia (CMML). To our best knowledge, this is a case of the oldest patient with suspected AML or CMML to have presented with spontaneous splenic rupture. Case Presentation: This is the case of a 74-year-old Hispanic female who presented to the emergency department complaining of substernal chest pressure and dyspnea. The patient had a past medical history of breast cancer (status post-mastectomy, chemotherapy, and radiation therapy), atrial fibrillation, and hypertension. Discussion Comments: Laboratory values at presentation demonstrated a white blood cell count of 88.3 x 10^9/L with 77% lymphocytes, hemoglobin of 10 g/dL, and a platelet count of 133 x 10^9/L. The patient underwent emergent proximal splenic artery embolization with interventional radiology. Peripheral blood smear demonstrated an abnormal immature monocytic cell population consistent with either AML with monocytic differentiation or CMML. Given the patient’s history, the may have been a long-term complication of her prior radiation therapy. The patient’s hospital course was complicated by multiple organ failure and was subsequently intubated. As per the family’s wishes, confirmatory bone marrow biopsy was not pursued and the patient was palliatively extubated. Conclusion: Spontaneous splenic hemorrhage is an extremely rare but important complication of AML and CMML that can result in death if not recognized and treated early.