A Bizarre Progression Of Chronic Lymphocytic Leukaemia Into Diffuse Large B-Cell Lymphoma

J Ayub Med Coll Abbottabad. 2023 Jul-Sep;35(3):512-514. doi: 10.55519/JAMC-03-11640.


A 65-year-old male presented with complaints of weakness, lethargy, abdominal pain, and low-grade fever for the last few months. His examination revealed generalized lymphadenopathy and splenomegaly. A subsequent laboratory workup revealed atypical lymphoid cells with prominent double-bright positivity of CD19 and CD5 markers. Further investigations revealed deletion of the ATM (11q22.3) gene, and by other diagnostic factors, the patient was diagnosed with B-cell chronic lymphocytic leukaemia. Thus, treatment was initiated with oral chemotherapy followed by rituximab-bendamustine. After three weeks, he presented to the emergency room with a fever and worsening abdominal pain. On examination, massive splenomegaly was found. After stabilization, a bone marrow biopsy revealed findings which, in light of the clinical symptoms, were consistent with Richter's transformation of B-Cell chronic lymphocytic leukaemia into Diffuse large B-Cell Lymphoma.

Keywords: Diffuse large B-Cell lymphoma; B-Cell chronic lymphocytic leukaemia; Richter’s transformation.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain
  • Aged
  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell* / complications
  • Leukemia, Lymphocytic, Chronic, B-Cell* / genetics
  • Lymphoma, Large B-Cell, Diffuse* / diagnosis
  • Lymphoma, Large B-Cell, Diffuse* / pathology
  • Male
  • Rituximab / therapeutic use
  • Splenomegaly


  • Rituximab