{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:02:41Z","timestamp":1776679361343,"version":"3.51.2"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic lymphocytic leukemia, a common B-cell malignancy in the elderly, is characterized by lymphocytosis, lymphadenopathy, and cytopenia. Concurrently, hepatic cirrhosis, defined by liver fibrosis and portal hypertension, often leads to overlapping clinical features such as splenomegaly and cytopenia, complicating the diagnosis and management of chronic lymphocytic leukemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present an 84-year-old Iranian male patient with established hepatic cirrhosis who presented with abdominal pain, massive splenomegaly, lymphocytosis, anemia, and cachexia. Initial evaluations revealed lymphocyte-dominant leukocytosis and smudge cells. Immunophenotyping confirmed chronic lymphocytic leukemia (cluster of differentiation 5+, cluster of differentiation 19+, cluster of differentiation 20+, cluster of differentiation 23+). Imaging demonstrated liver cirrhosis and portal hypertension with esophageal varices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic complexities of concurrent chronic lymphocytic leukemia and hepatic cirrhosis, necessitating a multidisciplinary approach and targeted diagnostic strategies to differentiate overlapping clinical manifestations. It underscores the importance of individualized treatment in such complex patients to optimize outcomes and enhance quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13256-026-05946-8","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T09:33:38Z","timestamp":1776504818000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concurrent hepatic cirrhosis and chronic lymphocytic leukemia: a challenging coexistence: a case report"],"prefix":"10.1186","volume":"20","author":[{"given":"Fatemeh Khodadadpour","family":"Mahani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazanin Zeinali","family":"Nezhad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reza","family":"Ghaderi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elham","family":"Jafari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mana","family":"Khazaeli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samaneh Omidi","family":"Kermanshahaninejad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Behrang","family":"Shamsinejad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"issue":"25","key":"5946_CR1","doi-asserted-by":"publisher","first-page":"2745","DOI":"10.1182\/blood-2017-09-806398","volume":"131","author":"M Hallek","year":"2018","unstructured":"Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, D\u00f6hner H, et\u00a0al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745\u201360.","journal-title":"Blood"},{"issue":"11","key":"5946_CR2","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1001\/jama.2023.1946","volume":"329","author":"M Shadman","year":"2023","unstructured":"Shadman M. Diagnosis and treatment of chronic lymphocytic leukemia: a review. JAMA. 2023;329(11):918\u201332.","journal-title":"JAMA"},{"key":"5946_CR3","doi-asserted-by":"publisher","DOI":"10.7754\/Clin.Lab.2017.170406","author":"M Falay","year":"2017","unstructured":"Falay M, \u00d6zet G. Immunophenotyping of chronic lymphocytic leukemia. Clin Lab. 2017. https:\/\/doi.org\/10.7754\/Clin.Lab.2017.170406.","journal-title":"Clin Lab"},{"issue":"1","key":"5946_CR4","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jhep.2018.09.014","volume":"70","author":"SK Asrani","year":"2019","unstructured":"Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151\u201371.","journal-title":"J Hepatol"},{"issue":"5","key":"5946_CR5","doi-asserted-by":"publisher","first-page":"1764","DOI":"10.1002\/hep.22273","volume":"47","author":"G Garcia\u2010Tsao","year":"2008","unstructured":"Garcia\u2010Tsao G, Bosch J, Groszmann RJ. Portal hypertension and variceal bleeding\u2014Unresolved issues. Summary of an American Association for the study of liver diseases and European Association for the study of the liver single\u2010topic conference. Hepatology. 2008;47(5):1764\u201372.","journal-title":"Hepatology"},{"issue":"1","key":"5946_CR6","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","volume":"69","author":"PR Galle","year":"2018","unstructured":"Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul J-L, et\u00a0al. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182\u2013236.","journal-title":"J Hepatol"},{"key":"5946_CR7","unstructured":"Gascoyne R, Campo E, Jaffe E, Swerdlow S, Harris N, Pileri S, et\u00a0al. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon, France: IARC. 2017."},{"issue":"4","key":"5946_CR8","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.4103\/jfmpc.jfmpc_1037_19","volume":"9","author":"R Singh","year":"2020","unstructured":"Singh R, Shaik S, Negi BS, Rajguru JP, Patil PB, Parihar AS, et\u00a0al. Non-Hodgkin\u2019s lymphoma: a review. J Family Med Prim Care. 2020;9(4):1834\u201340.","journal-title":"J Family Med Prim Care"},{"issue":"4","key":"5946_CR9","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1056\/NEJMoa1513257","volume":"374","author":"AW Roberts","year":"2016","unstructured":"Roberts AW, Davids MS, Pagel JM, Kahl BS, Puvvada SD, Gerecitano JF, et\u00a0al. Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med. 2016;374(4):311\u201322.","journal-title":"N Engl J Med"},{"issue":"5","key":"5946_CR10","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1097\/GIM.0b013e31819d30f2","volume":"11","author":"J Alexander","year":"2009","unstructured":"Alexander J, Kowdley KV. HFE-associated hereditary hemochromatosis. Genet Med. 2009;11(5):307\u201313.","journal-title":"Genet Med"},{"issue":"10390","key":"5946_CR11","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1016\/S0140-6736(23)00287-8","volume":"401","author":"PC Adams","year":"2023","unstructured":"Adams PC, Jeffrey G, Ryan J. Haemochromatosis. Lancet. 2023;401(10390):1811\u201321.","journal-title":"Lancet"},{"issue":"3","key":"5946_CR12","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1056\/NEJMoa1400376","volume":"371","author":"JC Byrd","year":"2014","unstructured":"Byrd JC, Brown JR, O\u2019Brien S, Barrientos JC, Kay NE, Reddy NM, et\u00a0al. Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. N Engl J Med. 2014;371(3):213\u201323.","journal-title":"N Engl J Med"},{"issue":"9","key":"5946_CR13","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1002\/ajh.24826","volume":"92","author":"M Hallek","year":"2017","unstructured":"Hallek M. Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment. Am J Hematol. 2017;92(9):946\u201365.","journal-title":"Am J Hematol"},{"issue":"12","key":"5946_CR14","doi-asserted-by":"publisher","first-page":"5446","DOI":"10.1182\/blood-2007-06-093906","volume":"111","author":"M Hallek","year":"2008","unstructured":"Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, D\u00f6hner H, et\u00a0al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute\u2013Working Group 1996 guidelines. Blood. 2008;111(12):5446\u201356.","journal-title":"Blood"},{"issue":"12","key":"5946_CR15","doi-asserted-by":"publisher","first-page":"2454","DOI":"10.1182\/blood-2012-03-420489","volume":"120","author":"PL Greenberg","year":"2012","unstructured":"Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Sol\u00e9 F, et\u00a0al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120(12):2454\u201365.","journal-title":"Blood"},{"issue":"3","key":"5946_CR16","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1002\/hep.24199","volume":"53","author":"J Bruix","year":"2011","unstructured":"Bruix J, Sherman M. Management of hepatocellular carcinoma: an Update\u0394\u03c3. Hepatology. 2011;53(3):1020\u20132.","journal-title":"Hepatology"},{"issue":"2","key":"5946_CR17","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1053\/jhep.2002.34944","volume":"36","author":"AJ Czaja","year":"2002","unstructured":"Czaja AJ, Freese DK. Diagnosis and treatment of autoimmune hepatitis. Hepatology. 2002;36(2):479\u201397.","journal-title":"Hepatology"},{"issue":"2","key":"5946_CR18","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a035220","volume":"11","author":"N Chiorazzi","year":"2021","unstructured":"Chiorazzi N, Chen S-S, Rai KR. Chronic lymphocytic leukemia. Cold Spring Harb Perspect Med. 2021;11(2): a035220.","journal-title":"Cold Spring Harb Perspect Med"},{"issue":"9","key":"5946_CR19","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.3324\/haematol.2019.236000","volume":"105","author":"J Delgado","year":"2020","unstructured":"Delgado J, Nadeu F, Colomer D, Campo E. Chronic lymphocytic leukemia: from molecular pathogenesis to novel therapeutic strategies. Haematologica. 2020;105(9):2205.","journal-title":"Haematologica"},{"key":"5946_CR20","doi-asserted-by":"crossref","unstructured":"Rotbain EHC. Comorbidity and survival in chronic lymphocytic leukemia: Syddansk Universitet; 2021.","DOI":"10.2147\/CLEP.S337495"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-026-05946-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-05946-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-05946-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T09:17:15Z","timestamp":1776676635000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13256-026-05946-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,18]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5946"],"URL":"https:\/\/doi.org\/10.1186\/s13256-026-05946-8","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,18]]},"assertion":[{"value":"10 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This case report was conducted in accordance with the ethical guidelines of the Declaration of Helsinki. While retrospective case reports often do not require specific Institutional Review Board (IRB) approval numbers at our institution, for enhanced ethical rigor, approval was obtained from the IRB of Kerman University of Medical Sciences. No specific approval number was assigned as per our institution\u2019s standard procedure for this type of submission. Prior to inclusion, the patient received comprehensive information detailing the study\u2019s objectives, procedures, potential risks, and benefits. Written informed consent was obtained, ensuring that the patient fully understood the study\u2019s nature and voluntarily agreed to participate. The consent process prioritized patient autonomy and confidentiality, adhering to the highest ethical standards in research involving human subjects. Written informed consent was obtained from the patient for the publication of this case report. The consent form elucidated the study\u2019s purpose, procedures, potential risks, and benefits, affirming the voluntary nature of participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflicts of interest relevant to this study. There are no financial or personal relationships with other people or organizations that could inappropriately influence (bias) the work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"208"}}