T-Cell Large Granular Lymphocytic Leukemia as a Cause for Severe Neutropenia

Jordan M Minish; Nadine Hamed; Robert Seifert; Amar H Kelkar

doi:10.7759/cureus.10186

T-Cell Large Granular Lymphocytic Leukemia as a Cause for Severe Neutropenia

Cureus. 2020 Sep 1;12(9):e10186. doi: 10.7759/cureus.10186.

Authors

Jordan M Minish¹, Nadine Hamed¹, Robert Seifert², Amar H Kelkar^{1

3}

Affiliations

¹ Department of Medicine, University of Florida, Gainesville, USA.
² Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, USA.
³ Division of Hematology and Oncology, University of Florida, Gainesville, USA.

Abstract

Large granular lymphocytic (LGL) leukemia is a rare, indolent disease that can cause destruction of neutrophils. We discuss the case of a previously healthy 63-year-old male who presented with severe, recurrent febrile neutropenia, in whom three bone marrow biopsies over 13 months failed to produce a diagnosis. He presented to our facility with persistent fevers and an absolute neutrophil count of 20 cells/mm³ (reference range 1,700-7,000 cells/mm³). A fourth bone marrow biopsy did not show clonal proliferation, but T-cell LGL leukemia was diagnosed based on the identification of T-cell rearrangements. We propose that LGL leukemia could be an underdiagnosed cause of severe neutropenia in patients with no overt malignancy or immunosuppressive therapy and that population-based database studies of patients with unexplained neutropenia may reveal more cases of this rare disease class.

Keywords: cytopenias; flow cytometry; lgl leukemia; neutropenia; oncology.

Publication types

Case Reports