Spontaneous Splenic Rupture Leading to the Diagnosis of CML

Spontaneous splenic rupture (SSR) is a known complication of hematologic malignancy. Rare cases have been reported in which patients presented with SSR prior to diagnosis of chronic myeloid leukemia (CML). We present a case of atraumatic SSR due to CML presenting as persistent abdominal pain.

A 42-year-old man presented with persistent left upper quadrant pain radiating to the lower quadrants ongoing for many months. He additionally had many other systemic symptoms including weight loss, night sweats, dark tarry stools, and progressive fatigue. Initial laboratory tests showed an anemia and a leukocytosis of 170 K/mm3 which uptrended to 230 K/mm³. CT abdomen showed spontaneous splenic rupture without major hemodynamic compromise and was treated conservatively. Peripheral smear was indicative of a chronic leukemia, and BCR-ABL testing was positive, leading to the diagnosis of CML - a rare cause of SSR.

We present a case of SSR as the inciting factor for a work-up revealing hematologic abnormalities and later CML. While splenic rupture has been shown to be present in patients with lymphoma and AML, it is an uncommon presenting symptom of CML and has only been documented in case reports. We urge clinicians to keep splenic rupture on the differential for persistent abdominal pain, as well as a thorough hematological workup for malignancy if hematologic lab abnormalities exist.