[Acute monoblastic leukemia complicated by fatal splenic rupture following initiation of chemotherapy]

Fatal chemotherapy splenic rupture is a rare event in acute leukemia. We report on a patient with acute monoblastic leukemia who developed splenic rupture 13 hours after the initiation of aggressive chemotherapy. Histologic studies of the spleen showed diffuse capsular infiltration and disseminated areas of subcapsular necrosis. Lysis of the leukemic cells and release of their enzymatic content, induced by the chemotherapy, probably led to proteolytic injury of the splenic capsule. We suggest that this mechanism may be an important pathogenetic factor in the occurrence of splenic rupture in patients with acute leukemia.