Concurrent hepatic cirrhosis and chronic lymphocytic leukemia: a challenging coexistence: a case report

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BACKGROUND: Chronic lymphocytic leukemia, a common B-cell malignancy in the elderly, is characterized by lymphocytosis, lymphadenopathy, and cytopenia. Concurrently, hepatic cirrhosis, defined by liver fibrosis and portal hypertension, often leads to overlapping clinical features such as splenomegaly and cytopenia, complicating the diagnosis and management of chronic lymphocytic leukemia. CASE PRESENTATION: We present an 84-year-old Iranian male patient with established hepatic cirrhosis who presented with abdominal pain, massive splenomegaly, lymphocytosis, anemia, and cachexia. Initial evaluations revealed lymphocyte-dominant leukocytosis and smudge cells. Immunophenotyping confirmed chronic lymphocytic leukemia (cluster of differentiation 5+, cluster of differentiation 19+, cluster of differentiation 20+, cluster of differentiation 23+). Imaging demonstrated liver cirrhosis and portal hypertension with esophageal varices. CONCLUSION: This case highlights the diagnostic complexities of concurrent chronic lymphocytic leukemia and hepatic cirrhosis, necessitating a multidisciplinary approach and targeted diagnostic strategies to differentiate overlapping clinical manifestations. It underscores the importance of individualized treatment in such complex patients to optimize outcomes and enhance quality of life.

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