Chronic Lymphocytic Leukemia (CLL) Clinical Presentation

Updated: Jan 30, 2023
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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History and Physical Examination


Patients with chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) present with a wide range of signs and symptoms. The onset is insidious, and it is not unusual for CLL to be discovered incidentally after a blood cell count is performed for another reason. Up to 80% of patients are asymptomatic at the time of diagnosis. [23]

Enlarged lymph nodes are the most common presenting sign in symptomatic patients. A predisposition to repeated infections such as pneumonia, herpes simplex labialis, and herpes zoster may also be seen. Early satiety and/or abdominal discomfort may be related to an enlarged spleen. Mucocutaneous bleeding and/or petechiae may be due to thrombocytopenia. Tiredness and fatigue may be present secondary to anemia; up to 10% of patients with CLL will present with an autoimmune hemolytic anemia. [2]

Richter syndrome or Richter transformation refers to the transformation of CLL into an aggressive large B-cell lymphoma and is seen in approximately 17% of high-risk patients. [2] Patients will often present with a constellation of "B symptoms", including weight loss, fevers, night sweats, and muscle wasting, as well as increasing hepatosplenomegaly and lymphadenopathy. Treatment remains challenging and prognosis is poor, with median survival of a few months.

Physical Examination

In addition to localized or generalized lymphadenopathy, patients may manifest the following:

  • Splenomegaly (30-54% of cases)
  • Hepatomegaly (10-20% of cases)
  • Petechiae
  • Pallor