Chronic Lymphocytic Leukemia Causing Gastric Ulcer Perforation: A Case Presentation and Literature Review.

Chronic lymphocytic leukemia (CLL) is a malignancy characterized by the progressive accumulation of lymphocytes in the bone marrow and lymphoid organs. Gastrointestinal manifestations are rare in all types of leukemia. Generally, this occurs during relapsing disease or in acute leukemias; however, recent advancements in treatment have reduced these complications. Most commonly, lesions in the stomach are hemorrhagic, and lesions in the lower gastrointestinal tract present as peritonitis or colitis. Our patient was unique because she had a perforated, rather than bleeding, peptic ulcer caused by infiltrative chronic lymphocytic leukemia after starting ibrutinib. Although this medication can impair wound healing and/or cause bleeding, there are no reports of perforation of existing ulcers. Additionally, chronic lymphocytic leukemia causing perforated peptic ulcer disease (PUD) is rare, and this is, to our knowledge, the first case of this phenomenon.