Splenic Rupture in a Pregnant Woman as the Onset of Chronic Myeloid Leukemia: A Case Report and Literature Review

Abstract

This is a clinical case of a 34-year-old patient in week 30 of gestation, debuting with Chronic Myeloid Leukemia (CML) complicated by acute splenic rupture secondary to massive splenomegaly. She was initially admitted for abdominal pain and laboratory findings compatible with CML in chronic phase. She received conservative treatment due to concerns about teratogenic effects. On day 7 she presented clinical deterioration with fetal distress, and exploratory laparotomy revealed massive hemoperitoneum due to a 12 cm splenic laceration. Emergency splenectomy and cesarean section were performed, with a healthy newborn. The patient evolved favorably. This is the first reported case of splenic rupture at the onset of gestational CML. The therapeutic challenges due to the fetal risk of tyrosine kinase inhibitors are discussed, as well as the importance of an interdisciplinary hematology-obstetrics-surgery approach to optimize maternal and neonatal outcomes.