Sarra Laabidi*, Amal Khsiba, Salwa Nechi, Houda Belfekih and Lamine Hamzaou
Chronic Lymphocytic Leukemia (CLL) is characterized by presence of abnormal monoclonal lymphocytes, circulating in blood that may infiltrate all organs, particularly those of lymphoreticular system. This disorder has a heterogeneous clinical course. Enlarged lymph nodes are the classical revealing manifestation. Gastrointestinal (GI) involvement in CLL, especially obstructive jaundice, is uncommonly reported, ranging from 5.7% to 13%. We report an isolated and unusual gastrointestinal involvement of CLL in an older patient. A 72-year-old man with Hepatitis C virus (HCV) infection presented an obstructive jaundice, revealing a Chronic Lymphocytic Leukemia (CLL) infiltration of hepatic hilar lymph nodes without another lymphadenopathy. CT-guided biopsy of lymph node mass confirmed neoplastic B-cell nature. Rituximab and Reduced Dose CHOP (R-miniCHOP) protocol, after plastic biliary stent placement, was established concomitantly with Direct anti-viral drugs (DAAs). The patient was achieving sustained virological response. After 6 cycles of chemotherapy, restaging studies revealed disappearance of hepatic hilar lymphadenopathy in CT-scan, performed 12 months later. The present case is an example of a rare presentation of CLL. It is extremely important to keep in mind the possibility of leukemic infiltrate, in case of unexplained intra-abdominal mass, especially in patients with HCV infection, and to highlight the probability to have a complete response to chemotherapy associated with DAAs.