Chronic Neutrophilic Leukemia in A 32-Year-Old Female. A Rare Discovery, Diagnostic Dilemma and review of the current literature.

Abstract

Chronic neutrophilic leukemia (CNL) is a rare disease, with an annual incidence of about 1 new case per million people, a little male preponderance and a median diagnostic age of approximately 65. The disease's clinical manifestations can range from asymptomatic to extremely symptomatic, with severe splenomegaly and constitutional symptoms. Most of CNL patients succumb from disease-related complications or progress to acute myeloid leukemia, which leaves their prognosis poor. A 32-year-old female experienced heartbeat awareness for 4 months, worsening over time, with fever, headache, dizziness, joint stiffness, pain, reduced joint movement, and body weakness. After initial evaluation and investigations, a diagnosis of CNL was reached with differential diagnoses of reactive neutrophilia/leukemoid reaction, chronic myeloid leukemia (CML), neutrophilic-CML (CML-N). Clinicians should have a high index of suspicion to diagnose and differentiate them. Immediate treatment was initiated to stabilize the patient before further diagnostic workups but disease rapid progression and the impact limited diagnostic investigations on patient outcomes. Therefore, a streamlined approach to managing CNL is crucial in time-sensitive situations, as it ensures prompt accurate diagnosis and intervention.