Case Report DOI 10.3349/ymj.2010.51.1.138 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 51(1): 138-140, 2010 A Case of Pathologic Splenic Rupture as the Initial Manifestation of Acute Myeloid Leukemia M2 Ji-Sun Han,1 Sung Yong Oh,1 Sung-Hyun Kim,1 Hyuk-Chan Kwon,1 Sook Hee Hong,2 Jin Yeong Han,3 Ki-Jae Park,4 and Hyo-Jin Kim1 1Departments of Internal Medicine, 2Pathology, 3Laboratory Medicine, and 4Surgery, Dong-A University College of Medicine, Busan, Korea. A pathologic splenic rupture refers to a rupture without trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare. In this study, we described a rare case of acute myeloid leukemia present- ing principally as an acute abdomen due to a pathologic splenic rupture in a 35-year old male patient. We can assert that a pathologic splenic rupture in hematologic diseases is a potentially life-threatening complication, which necessitates immediate operative intervention. Any such patient complaining about left upper abdominal tenderness should be closely observed, and further diagnostic investigations (ultrasonograph of the abdomen, abdominal CT scan) should be initiated in order to rule out a splenic rupture. The oncologist should be aware of this rare initial presentation of acute myeloid leukemia (AML) M2, as the condition generally necessitates a prompt splenectomy. Key Words: Acute myeloid leukemia M2, pathologic, splenic rupture Received: April 14, 2008 Revised: June 6, 2008 Accepted: June 6, 2008 Corresponding author: Dr. Hyo-Jin Kim, Department of Internal Medicine, Dong-A University College of Medicine, 3-1 Dongdaesin-dong, Seo-gu, Busan 602-715, Korea. Tel: 82-51-240-2951, Fax: 82-51-240-2951 E-mail: kimhj@dau.ac.kr ∙The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2010 138 INTRODUCTION Pathologic splenic ruptures re a rare and life-threatening complication of acute leukemia.1,2 A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare, and only a few cases have been reported thus far in worldwide literature.3-5 It is an abdominal emergency which requires immediate diagnosis via an abdominal ultrasound and prompt splenectomy in order to ensure the survival of the patient. In this study, we describe a case of a pathologic splenic rupture as the initial manifestation of acute myeloid leukemia (AML) M2. CASE REPORT A 35-year old man was admitted to our hospital with a four-day history of peri- umbilical pain with dyspepsia and abdominal distension. The patient had no history of trauma. Upon physical examination, we noted generalized guarding with tenderness and rebound tenderness over the upper abdomen. The enhanced computed tomography (CT) scan of the abdomen/pelvis indicated multiple splenic lacerations, hepatosplenomegaly, and fluid collections in the perihepatic, perisplenic, both paracolic gutters, and pelvic cavity (Fig. 1). The patient underwent a splenectomy. The operative finding was a massively enlarged spleen with multiple transverse lacerations. The microscopic findings of the spleen revealed diffuse infiltration of myeloperoxidase (MPO)-stained leuke- mic blasts (Fig. 2). His complete blood count (CBC) revealed the following: total white blood cell count of 21,099/µL, hemoglobin of 7.6 g/dL, and platelet count Yonsei Med J http://www.eymj.org Volume 51 Number 1 January 2010