A Case of Aggressive NK-Cell Leukemia Diagnosed with Severe Epistaxis

We report a case of severe epistaxis resulting in an unfortunate clinical course. A 35-year-old man seen for bilateral nasal obstruction, a top-heavy feeling, and general fatigue was found to have bilateral swollen nasal mucosae and a completely obstructed nasal airway. Sinonasal X-ray showed the pansinuses to be occupied. Nasal treatment caused such immediate excessive bilateral epistaxis. Disturbance of consciousness occurred. The bleeding could not be arrested completely even under general anesthesia. Astriction was done using anterior packing and posterior balloon tamponade. Perioperative blood examination showed thrombocytopenia, disseminated intravascular coagulation (DIC), electrolyte abnormality, hepatic dysfunction, and overwhelming acidosis, requiring that the man be managed in the intensive care unit (ICU), where he also suffered hemophagocytic syndrome and multiple organ failure (MOF). The diagnosis from bone-marrow biopsy and flow cytometry was aggressive natural killer (NK) cell leukemia (ANKL). Despite chemotherapy with steroids, etoposide, and L-asparaginase, he died of hemorrhagic pneumonia one month after the final diagnosis. Given such nasal symptoms with a worsening general condition due to latent blood dyscrasia, blood examinations should be done even before attempting nasal treatment.