Chronic 2

A 72 year old woman presents with progressive, bilateral hearing loss for 1 year.

She was treated for bilateral otitis media earlier, which included placement of myringotomy tubes. However, her symptoms have not improved.

Close questioning reveals a history of chronic fatigue and dyspnea on exertion for more than 2 years, which she attributed to old age.

Her medical, surgical and family histories are unremarkable and she is not on any medications currently.

Her complete blood count reveals a leukocyte count of 85,600 with 80% lymphocytes, a hemoglobin level of 10.9 g/dL, and a platelet count of 130,000/mm3.

A peripheral blood film reveals lymphocytosis, thrombocytopenia and smudge cells.

Select Relevant Investigations
Flow Cytometry

Performed

Flow Cytometry shows the peripheral blood lymphocytes to be positive for the B-cell markers CD19, CD20, with co-expression of the T-cell markers CD5 and CD23. They are negative for CD10, Cyclin-D, FMC7, and CD79b.
Bone Marrow Aspiration and Biopsy

Performed

Bone marrow studies reveal central nodules of mature-appearing lymphocytes, with a diffuse background infiltrate intimately admixed with the hematopoietic tissue; this is consistent with B-cell Chronic Lymphocytic Leukemia (CLL).
Biopsy Tympanic Membrane

Performed

The biopsy demonstrates infiltration with mature-appearing lymphocytes consistent with CLL.
CSF Analysis

Performed

Cerebrospinal Fluid analysis demonstrates the presence of clonal lymphocytes; immunohistochemical studies reveal that approximately 80% of cells are positive for the B-cell marker CD20.

Select Relevant Management
Blood Transfusion
Prophylactic Antibiotics
Systemic Chemotherapy
Allogeneic Stem Cell Transplant