Rechute d’une leucémie aigüe lymphoblastique révélée par une fissure anale

Abstract

Proctological damage is very frequently encountered in acute leukemia (AL), it can be indicative of the disease and occur latter. We report the observation of a 65-year-old patient with no known comorbidities, followed for 2 years for lymphoblastic leukemia Phenotype B with PH positive, treated by GRAAPH protocol associated with a 1st generation tyrosine kinase inhibitor (TKI). She relapsed a year after the end of chemotherapy and presented with severe terminal constipation with proctalgia progressing in a context of fever, deterioration of general condition and anorexia. The clinical examination found intense paleness, performans status at 3, without organomegaly or hemorrhagic signs, the proctological examination found a large posterior anal fissure very painful with hypertonic sphincter. The biological exam shows normochromic normocytic anemia at 5g/L and thrombocytopenia at 3000 element/mm3 and blast hyperleukocytosis at 70,000 element/mm3. The bone marrow aspiration coupled with immunophenotyping confirms relapse of ALL phenotype B, and karyotype and FISH demonstrate the presence of t (9.22) and the Bcr-Abl rearrangement. A medical treatment of the fissure was instituted based on laxatives and healing ointment, associated with salvage chemotherapy and 2nd generation TKI. Proctologically, the outcome was favorable with the disappearance of proctalgia and the onset of healing of the anal fissure. On the other hand, on the hematological level, the patient was refractory to chemotherapy and died due to the evolution of her disease.