A rare case of chronic myeloid leukemia with acquired von Willebrand disease presenting as subdural hematoma.

We report a case of a 32-year-old lady with chronic myeloid leukemia (CML) on Imatinib for the past four years and in complete clinical, hematological and molecular remission who presented to us with sudden onset of headache, vomiting and diplopia following self discontinuation of Imatinib for a month. Investigations were suggestive of chronic phase CML (CML-CP) with massive thrombocytosis and magnetic resonance imaging (MRI) of the brain revealed subdural hematoma. Coagulation studies confirmed the diagnosis of Acquired von Willebrand disease (AvWD) 2A because of thrombocytosis. The patient also tested positive for mutation T315I in bcr-abl gene. Treatment of the patient with high dose of Imatinib and hydroxyurea led to normalisation of platelet counts, reversal of coagulation defect and subsidence of symptoms. The present case highlights the importance of diagnosis of AvWD to determine the cause of bleeding in CML and distinguish it from Imatinib-induced bleeding, as prompt treatment with Imatinib can achieve reversal of the condition.