Unusual presentation of spontaneous splenic rupture.

We report a case of a 47-year-old man who presented with hypotension after 2 weeks of fatigue and upper respiratory infection symptoms, and rapidly deteriorated in the emergency department. A bedside ultrasound revealed free intraperitoneal fluid, a subsequent diagnostic peritoneal lavage showed hemoperitoneum, and a laparotomy confirmed a splenic rupture. Pathology results revealed a relatively rare form of leukemia, known as hairy cell leukemia, leading to this presentation. We discuss the differential diagnosis of spontaneous (or without antecedent trauma) splenic rupture with a review of hairy cell leukemia, and stress the importance of keeping a high index of suspicion for medical diseases that affect the spleen.