Leukostasis Presenting as Focal Hemorrhagic Lesions in the Brain: An Underrecognized But Life-threatening Complication of Leukemia

Singh Ria BS^1, , Cotant Matthew B MD² and Krishnan Anant MD³

¹Kansas City University College of Osteopathic Medicine 1750 Independence Avenue, Kansas City, Missouri, 64106

²Corewell Health William Beaumont University Hospital 3577 West 13 Mile Road, Royal Oak, Michigan, 48073

³Corewell Health William Beaumont University Hospital3601 W 13 Mile Rd, Royal Oak, Michigan, 48073

Cite this paper:
Singh Ria BS, Cotant Matthew B MD and Krishnan Anant MD. Leukostasis Presenting as Focal Hemorrhagic Lesions in the Brain: An Underrecognized But Life-threatening Complication of Leukemia. American Journal of Medical Case Reports. 2024; 12(9):138-140. doi: 10.12691/ajmcr-12-9-2

Abstract

Leukostasis, which refers to increased blood viscosity due to the increased white blood cell count, is a critical condition observed in acute myeloid leukemia and is associated with significant morbidity and mortality. The excessive accumulation of white blood cells can lead to the occlusion of small vessels in various body parts such as brain and lungs, resulting in corresponding clinical symptoms. We discuss a patient with history of breast cancer and newly diagnosed leukemia whose head CT revealed multiple defined hemorrhages that were suspected to represent hemorrhagic metastasis. Findings on serial imaging and correlation with patient’s blood work, led to an alternate diagnosis of leukostasis with intracranial manifestations. This was also confirmed on the subsequent MRI. The intracranial involvement of leukostasis is rarely discussed in practice or literature such that we hope our case report will facilitate increased awareness of the condition.

Keywords:
Acute myeloid leukemia leukostasis hemorrhages white blood cells blood viscosity

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References:

[1]	Stucki A, Rivier AS, Gikic M, Monai N, Schapira M, Spertini O. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood. 2001; 97(7): 2121-2129.
[2]	Giammarco S, Chiusolo P, Piccirillo N, et al. Hyperleukocytosis and leukostasis: management of a medical emergency. Expert Rev Hematol. 2017; 10(2): 147-154.
[3]	Macaron W, Sargsyan Z, Short NJ. Hyperleukocytosis and leukostasis in acute and chronic leukemias. Leuk Lymphoma. 2022; 63(8): 1780-1791.
[4]	Siegel RL , Giaquinto AN , Jemal A . Cancer statistics, 2024. CA Cancer J Clin. 2024; 74(1): 12-49.
[5]	Lind M, Vernon C, Cruickshank D, et al. The level of haemoglobin in anaemic cancer patients correlates positively with quality of life. Br J Cancer. 2002; 86(8): 1243-1249.
[6]	Meyer HJ, Beimler M, Borte G, Pönisch W, Surov A. Radiological and clinical patterns of myeloid sarcoma. Radiol Oncol. 2019; 53(2): 213-218. Published 2019 Mar 14.
[7]	Bewersdorf JP, Zeidan AM. Hyperleukocytosis and Leukostasis in Acute Myeloid Leukemia: Can a Better Understanding of the Underlying Molecular Pathophysiology Lead to Novel Treatments?. Cells. 2020; 9(10): 2310. Published 2020 Oct 17.
[8]	Lichtman MA, Rowe JM. Hyperleukocytic leukemias: rheological, clinical, and therapeutic considerations. Blood. 1982; 60(2): 279-283.
[9]	Röllig C, Ehninger G. How I treat hyperleukocytosis in acute myeloid leukemia. Blood. 2015; 125(21): 3246-3252.
[10]	Ali AM, Mirrakhimov AE, Abboud CN, Cashen AF. Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest. Hematol Oncol. 2016; 34(2): 69-78.
[11]	Algharras AA, Mamourian A, Coyne T, Mohan S. Leukostasis in an Adult with AML Presenting as Multiple High Attenuation Brain Masses on CT. J Clin Diagn Res. 2013; 7(12): 3020-3022.