Underlying Chronic Lymphocytic Leukemia in a Case of Vivax Malaria With Thrombocytopenia: A Case Report

TL;DR

A patient with malaria and low platelet count was found to also have chronic lymphocytic leukemia.

Contribution

Highlights a rare case linking malaria thrombocytopenia with underlying chronic lymphocytic leukemia.

Findings

A patient with Plasmodium vivax malaria had severe thrombocytopenia and leukocytosis.

Flow cytometry confirmed a diagnosis of chronic lymphocytic leukemia in the patient.

The case suggests that thrombocytopenia with leukocytosis in malaria may indicate an underlying malignancy.

Abstract

Thrombocytopenia is a very commonly known complication of malaria. A 64-year-old male presented with high-grade fever, extensive petechial rashes, subconjunctival hemorrhage, and mucosal oral bleeds. Laboratory tests revealed severe thrombocytopenia (platelet count: 15,000 per cubic millimeter), leukocytosis (total leukocyte count (TLC): 29,100 per microliter), and coagulopathy (international normalized ratio: 4.2). Infection was ruled out by negative cultures. The smear was positive for Plasmodium vivax. Flow cytometry was done, and a diagnosis of chronic lymphocytic leukemia (CLL) was made. The association of leukocytosis with thrombocytopenia in the case of malaria, in the absence of sepsis - as in our patient - should raise a suspicion of underlying CLL.

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