Pleural involvement revealing chronic lymphocytic leukemia: A case report

Abstract

Pleural involvement revealing chronic lymphocytic leukemia (CLL) is a rare phenomenon. CLL is a hematologic malignancy characterized by an excessive proliferation of B lymphocytes. Although CLL typically presents with symptoms such as fatigue, frequent infections, and lymphadenopathy, in some cases, it may initially manifest with pleural involvement. This involvement can present as a pleural effusion, leading to symptoms such as dyspnea, chest pain, and a dry cough. Diagnosis relies on cytological analysis of pleural fluid, biopsy, and additional tests such as immunophenotyping. Management includes treatment of the underlying CLL, often with a combination of chemotherapy and immunotherapy. We report the case of a 53-year-old male, a former farmer and chronic smoker, who presented with stage III dyspnea (according to Sadoul), dry cough, and right-sided lower thoracic pain. These symptoms were associated with a general decline in his health status. Clinical examination revealed signs of right-sided pleural effusion, multiple lymphadenopathies (cervical, axillary, inguinal), and hepatosplenomegaly. Laboratory tests showed significant lymphocytosis. A pleural puncture revealed a lymphocytic exudative fluid, and pleural biopsy showed granulomatous inflammation without caseous necrosis. Immunohistochemistry highlighted an abnormal population of B lymphocytes expressing CD19, CD5, CD20, CD23 markers, and a monoclonal population with a predominance of the kappa light chain, thus confirming the diagnosis of chronic lymphocytic leukemia. After confirmation of the stage C CLL diagnosis, the patient was treated with chemotherapy (CHOP protocol).