Hearing Loss and CLL: a Rare Complication of Leukostasis

Hussein Gaith^1, , Jad Said¹, Antoine Egbe¹, Myles Hardeman² and Priscella Holland²

¹Corewell Health East, Dearborn, USA

²Wayne State University, Detroit, USA.

Cite this paper

Hussein Gaith, Jad Said, Antoine Egbe, Myles Hardeman and Priscella Holland. Hearing Loss and CLL: a Rare Complication of Leukostasis. American Journal of Medical Case Reports. 2023; 11(8):150-151. doi: 10.12691/AJMCR-11-8-5

Abstract

In chronic lymphocytic leukemia (CLL), hyperleukocytosis has a prevalence of 20-40%, but leukostasis is extremely rare. In this case, a 53-year-old male with no known medical history presented to the emergency department with acute bilateral hearing loss, shortness of breath, diffuse lymphadenopathy, weight loss, and an abdominal mass, and was found to have hyperleukocytosis (WBC: 1075.5 bil/L), anemia (Hb: 2.2 g/dL), and thrombocytopenia (Platelets: 33 bil/L). Flow cytometry and lymph node biopsy found chronic lymphocytic leukemia with a 13q14.3 deletion, and subsequently started on venetoclax resulting in resolution of the leukocytosis and thrombocytopenia. Persistent hearing loss led to attempting oral and intratympanic corticosteroids, which also failed to restore hearing. No lesions were found in the bilateral internal auditory canals on MRI. Unlike previous cases of hearing loss in CLL-related leukostasis, this patient's hearing loss did not resolve with CLL resolution, which suggests that increased viscosity versus other unidentified etiologies are the cause. Further studies need to be conducted in this subset of patients to better understand and combat the mechanisms behind CLL-related leukostasis hearing loss.

Keywords

CLL, Hearing Loss, Leukostasis, Hyperviscosity, hyperleukocytosis, Leukemia.

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Macaron, W., Sargsyan, Z., & Short, N. J. (2022). Hyperleukocytosis and leukostasis in acute and chronic leukemias. Leukemia & Lymphoma, 1-12.
[2]	Hallek M, Al-Sawaf O. Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol. 2021 Dec 1;96(12):1679-1705.
[3]	Preston FE, Sokol RJ, Lilleyman JS, Winfield DA, Blackburn EK. Cellular hyperviscosity as a cause of neurological symptoms in leukaemia. Br Med J. 1978 Feb 25;1(6111):476-8.
[4]	Baer MR, Stein RS, Dessypris EN. Chronic lymphocytic leukemia with hyperleukocytosis. The hyperviscosity syndrome. Cancer. 1985 Dec 15;56(12):2865-9.
[5]	Nageris B, Or R, Hardan I, Polliack A. Sudden onset deafness as a presenting manifestation of chronic lymphocytic leukemia. Leuk Lymphoma. 1993 Feb;9(3):269-71.
[6]	Lossos IS, Berger S, Gomori M, Leibovich G, Matzner Y. Hearing loss and leukocytosis. Postgrad Med J. 1996 Mar;72(845):183-5.
[7]	Singh N, Singh Lubana S, Dabrowski L, Sidhu G. Leukostasis in Chronic Lymphocytic Leukemia. Am J Case Rep. 2020 Jul 3;21:e924798.
[8]	Stucki A, Rivier AS, Gikic M, et al. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood. 2001; 97(7):2121–2129.