Complications of a patient with chronic lymphocytic leukemia: A Case Report

Abstract

Introduction: Chronic lymphocytic leukemia (CLL) and myasthenia gravis (MG) are chronic health conditions that require specific treatments and present distinct challenges for dental management, especially in surgical procedures such as tooth extraction. Patients with CLL often have coagulation dysfunctions due to hematological changes associated with the disease and immunosuppressant treatments. Myasthenia gravis, an autoimmune disease characterized by muscle weakness, often requires the use of corticosteroids and immunosuppressants, which can also increase the risk of bleeding. Objective: To discuss a clinical case of a patient with a previous diagnosis of Myasthenia gravis and chronic lymphocytic leukemia (CLL), with various complications, multiple hospitalizations and intercurrences, and to analyze the complications presented by the patient. Method: A descriptive study based on a case report. The clinical characteristics, evolution of the condition and specific complications faced by the patient were detailed. Case Report: After stabilization measures, a fistulectomy was performed on the wound site and corticosteroid therapy was started. The patient's general condition improved, his laboratory tests improved, the bleeding stopped and the wound closed. He was referred to the outpatient clinic for further follow-up and treatment. After a period of time, the patient returned to the same hospital complaining of asthenia, malaise, dyspnea on slight exertion, and an associated hyperglycemic peak of 300mg/dL. Tests again showed a drop in hemoglobin, with HB: 7.2, leukocytes of 9240 mm3 and a chest CT scan showing pneumonia. He was given 10 days of intravenous antibiotic therapy, ceftriaxone 2g a day. In addition, immunophenotyping was requested to assess the possibility of a recurrence of CLL, which showed a report of chronic lymphoproliferative B-KAPPA. On discharge, he was referred back to the hematologist to start a new cycle of chemotherapy. Due to his previous use of chemotherapy drugs, he opted for treatment with Venetoclax. He is currently undergoing treatment with Venetoclax, with no complications, and is being monitored on an outpatient basis. Conclusion: This case highlights the complexity of managing patients with hematological and autoimmune diseases undergoing invasive dental procedures. Multiprofessional coordination is essential to reduce risks and improve prognosis. The literature indicates that careful assessment of the hematological condition and immunosuppressive status is essential for the prevention of hemorrhagic complications.

Keywords: Chronic lymphocytic leukemia; myasthenia gravis; hematological and autoimmune diseases