PMC9877286_01
Peripheral blood smear with Wright-Giemsa staining showing hairy cell with abundant pale blue cytoplasm, slightly irregular nucleus with ground glass chromatin and hairy cell projections.
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A peripheral blood smear showed significant lymphocytosis with oval to slightly irregular nuclei, homogenous ground-glass chromatin, and abundant pale blue cytoplasmic hairy projections, normocytic anemia with anisopoikilocytosis, and marked thrombocytopenia ( Figure 1 ).
CT chest (axial) showing diffuse ground glass opacities in bilateral lung parenchyma and no radiologic evidence of pulmonary hemorrhage.
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With worsening shortness of breath, increasing oxygen requirement, and the CT findings concerning leukostasis ( Figure 2 ), he was started on hydroxyurea 2 g daily and underwent three sessions of leukapheresis over a period of a week with significant cytoreduction.
(A) Magnetic resonance imaging (axial section) of brain at recurrence showing numerous non-enhancing lesions (only showing index lesions) in the supratentorial and infratentorial brain with susceptibility artifact and subtle restricted diffusion of the margins and T2 hyperintense signals surrounding them, with the largest lesion in the left cerebellar vermis (14x12mm). (B) Follow up MRI after 4 months showing resolution of the non-enhancing lesions and only a small foci of low signal intensity noted within the posterior fossa representing chronic hemorrhage.
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This was followed by a magnetic resonance imaging (MRI) of the head with and without contrast, which showed multiple soft tissue masses in the supratentorial and infratentorial regions involving the cerebellar lobes, the left frontal and bilateral temporal lobes, with the largest lesion seen in the left cerebellum (14 x 12mm) ( Figure 3A ). Figure 3B ), and abdominal imaging revealed a marked decrease in spleen size. Follow-up ophthalmologic evaluation showed resolution of leukemic retinopathy.