Richter's syndrome: a case report.

OBJECTIVE

To report a case of Richter's syndrome found in one of the teaching hospitals in Nigeria in the context of sparse earlier reports of Richter's syndrome in western Africa.

CLINICAL PRESENTATION AND INTERVENTION

A 52-year-old male had been diagnosed earlier as having chronic lymphocytic leukaemia (CLL) and treated for 6 months with chlorambucil, although compliance was poor and the patient eventually stopped treatment. He presented to our hospital 18 months later with clinical features in keeping with Richter's syndrome. The blood and bone marrow smear review, together with fine-needle aspiration cytology of the masses, showed diffuse large cells of non-Hodgkin lymphoma consistent with the Richter's syndrome stage of CLL. There was significant improvement in response to the first 4 cycles of CHOP chemotherapy (consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone) instituted, but then there were features of relapse.

CONCLUSION

The case report serves to increase awareness and improve the index of suspicion about the terminal phase of CLL and low-grade lymphoma. It equally emphasizes the great need to strengthen further the laboratory diagnosis of haematological malignancies in developing countries.