Sudden hearing loss as the initial manifestation of chronic myeloid leukemia in a child

Area of Science:

• Hematology
• Ophthalmology
• Neurology

Background:

• Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the Philadelphia chromosome.
• Neurologic and ophthalmologic complications are rare in CML, often associated with hyperleukocytosis and hyperviscosity syndrome.

Observation:

• A 12-year-old girl presented with unilateral hearing loss as the initial symptom of CML.
• Following treatment initiation, she developed contralateral hearing loss and left-eye blindness.
• Investigations revealed severe sensorineural hearing loss, moderate mixed hearing loss, optic neuropathy, subhyaloid hemorrhage, and cerebral microhemorrhages.

Findings:

• The patient's presentation suggested leukostasis and hyperviscosity syndrome secondary to CML.
• Initial white blood cell count was markedly elevated at 181,700/mm3.
• The patient unfortunately succumbed to the condition within 9 days of hospitalization.

Implications:

• This case underscores CML as a rare but critical differential diagnosis for sudden-onset hearing loss, particularly in pediatric patients.
• Early recognition and management of hyperleukocytosis in CML are crucial to prevent potentially devastating neurologic and ophthalmologic complications.
• The case highlights the severe and rapid progression possible in CML, even with treatment initiation.