Sarra Laabidi,
Chronic Lymphocytic Leukemia (CLL) is characterized by presence of abnormal monoclonal lymphocytes, circulating in blood that may infiltrate all organs, particularly those of lymphoreticular system. This disorder has a heterogeneous clinical course. Enlarged lymph nodes are the classical revealing manifestation. Gastrointestinal (GI) involvement in CLL, especially obstructive jaundice, is uncommonly reported, ranging from 5.7% to 13%. We report an isolated and unusual gastrointestinal involvement of CLL in an older patient. A 72-year-old man with Hepatitis C virus (HCV) infection presented an obstructive jaundice, revealing a Chronic Lymphocytic Leukemia (CLL) infiltration of hepatic hilar lymph nodes without another lymphadenopathy. CT-guided biopsy of lymph node mass confirmed neoplastic B-cell nature. Rituximab and Reduced Dose CHOP (R-miniCHOP) protocol, after plastic biliary stent placement, was established concomitantly with Direct anti-viral drugs (DAAs). The patient was achieving sustained virological response. After 6 cycles of chemotherapy, restaging studies revealed disappearance of hepatic hilar lymphadenopathy in CT-scan, performed 12 months later. The present case is an example of a rare presentation of CLL. It is extremely important to keep in mind the possibility of leukemic infiltrate, in case of unexplained intra-abdominal mass, especially in patients with HCV infection, and to highlight the probability to have a complete response to chemotherapy associated with DAAs.