Chronic myeloid leukaemia (CML) presenting with pleural effusion

Abstract

Background: Chronic myeloid leukaemia presenting with pleural effusion as the initial clinical manifestation is very rare and poorly understood.
Case Presentation: We report a 34year old woman with CML (accelerated phase) in whom the initial clinical presentation was pleural effusion. She had a four week history of chest pain and cough, one week history of progressive difficulty in breathing and a history of weight loss and recurrent low-grade fever. On examination, she was a chronically ill-looking young woman in respiratory distress, pale, with tachycardia, tachypnoea and stony dull percussion notes and absent breath sounds on the right hemi-thorax. She also had splenomegaly and hepatomegaly. An initial diagnosis of disseminated Tuberculosis was ruled out by a full blood count and bone marrow aspiration cytology suggestive of a chronic myeloid leukaemia and confirmed by positive BCR-ABL transcripts. She was commenced on cytoreduction but demonstrated features of Tumour Lysis Syndrome after initiation of cytore-duction despite prophylaxis, warranting multidisciplinary care and haemodialysis. When she became clinically stable, she was referred for enrolment into Glivec International Patient Assistance Program (GIPAP) and she was commenced on Imatinib mesylate 600mg daily on account of CML in accelerated crisis. However, she was lost to follow up after her enrolment into the program.
Conclusion: Pleural effusion as the initial clinical manifestation of chronic myeloid leukemia (CML) is very rare  so high index of suspicion  should be maintained in the context  of these unusual manifestations of CML.