Abstract
T-cell prolymphocytic leukemia (T-PLL) is a very rare and aggressive lymphoproliferative disorder. We present a 70-year-old man with complaints of fatigue, low urinary output, and peripheral edema for one month. Objectively, he presented diminished respiratory sounds bilaterally and peripheral edema. Analytical study revealed mild anemia and mild lymphomonocytosis, acute kidney injury, and urinalysis with proteins, leukocytes, erythrocytes, and cylinders. Chest radiography was consistent with pleural effusion. Subsequent study showed new onset of thrombocytopenia with a progressive increase of lymphocytosis, in association with inguinal adenopathies and splenomegaly. Immunophenotypic study of peripheral blood and lymph node biopsy were compatible with the diagnosis of T-PLL. Negative serology for human T-cell lymphotropic virus type 1 (HTLV-1) excluded adult T-cell leukemia. Progressive changes in the peripheral blood smear were seen, finally showing the presence of lymphocytes with a cerebriform nucleus, revealing this variant. There was a rapid catastrophic progression, spontaneous tumor lysis syndrome, and death.
Highlights
Little is known about T-cell prolymphocytic leukemia (T-PLL)
We present a 70-year-old man with complaints of fatigue, low urinary output, and peripheral edema progressively increasing for one month
There is mostly uncertainty about the frequency of various clinical and laboratory findings [5]. This specific case is of particular interest because it presented with mild complaints and with non-specific laboratory changes that quickly escalated with lymphocytosis and acute kidney injury with catastrophic results
Summary
Little is known about T-cell prolymphocytic leukemia (T-PLL). It is a rare and aggressive lymphoproliferative disorder composed of post-thymic T cells and usually involves peripheral blood, bone marrow, lymph nodes, and spleen [1,2]. We present a 70-year-old man with complaints of fatigue, low urinary output, and peripheral edema progressively increasing for one month. He had no other complaints, namely orthopnea, palpitations, chest pain, cough or sputum, fever, night sweats, or weight loss. He had a medical history of arterial hypertension, dyslipidemia, and Parkinson's disease; he was medicated with losartan, amlodipine, simvastatin plus ezetimibe, rasagiline, levodopa, carbidopa, entacapone, rivastigmine, amantadine, ropinirole, omeprazole, acetylsalicylic acid, mirtazapine, sertraline, diazepam, clonazepam, and quetiapine
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