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            [0] => Richter's Syndrome Following Chronic Lymphocytic Leukemia  remission First Manifested as Pathologic Fracture of the Femur;case report
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    [etablissement] => Array
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            [0] => EPS FATTOUMA BOURGUIBA
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    [nom] => Array
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            [0] => HABIB
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    [prenom] => Array
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            [0] => HADJ TAIEB
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            [0] => habib.hadjtaieb@gmail.com
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Nom prénom / Name Surname: Habib HADJ TAIEB
Email: habib.hadjtaieb@gmail.com
Hôpital / Hospital: EPS FATTOUMA BOURGUIBA

 
Nom prénom / Name Surname: SABER REBHI
Email: r.saber17@gmail.com
Hôpital / Hospital: EPS FATTOUMA BOURGUIBA

 
Nom prénom / Name Surname: AHMED MDAOUKHI
Email: 
Hôpital / Hospital: EPS FATTOUMA BOURGUIBA

 
Nom prénom / Name Surname: YOUSSEF OTHMEN
Email: 
Hôpital / Hospital: EPS FATTOUMA BOURGUIBA

 
Nom prénom / Name Surname: MAKREM ZRIG
Email: 
Hôpital / Hospital: EPS FATTOUMA BOURGUIBA

 
Nom prénom / Name Surname: ABDERZZEK ABID
Email: 
Hôpital / Hospital: EPS FATTOUMA BOURGUIBA

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            [0] => Richter's Syndrome , Chronic Lymphocytic Leukemia  remission; femur fracture;

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            [0] => 3663
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            [0] => habib.hadjtaieb@gmail.com
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    [specialite] => Array
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            [0] => Chirurgie orthopédique et traumatologique
        )

    [pays] => Array
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            [0] => Tunisie
        )

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            [0] => Introduction: 
Richter syndrome (RS) is defined as the occurrence of an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL) and rarely Hodgkin lymphoma (HL), in a patient with prior or concomitant chronic lymphocytic leukemia (CLL).
Bony involvement in leukemia is most commonly associated with acute lymphoblastic or acute myeloblastic leukemia.3 CLL leading to pathological fracture is a rare phenomenon.
Case description; 
Female aged 65 ans with a medical history of arterial hypertension , autoimmune hemolytic anemia treated with corticosteroide ; chronic lymphocytic leukemia diagnosed in 2020  and treated for 2 years remised in october 2022 ; supracondylar fracture in October 2022 treated with retrograde femoral nail  ;  consulted in January 2023 ( 3month post op) with limited knee rang motion ; diffuse left thigh pain ; swelling on the operative scar . 
Radiographs revealed extensive lytique image in the 1/3 distal of the left femur englobing the whole nail .
CT scan showing  a mass centered on the nail and the lower third of the femur well limited homogeneous isodense in relation to the muscles pushing back the compartments without infiltrating them associated with metaphyseal bone lysis.

Patient was admitted in monastir orthopedic department  ; a biopsy was done reveals a  : transformation of Chronic Lymphocytic Leukemia into a large B-cell lymphoma ; 
During admission patient has showing a deterioration of general condition ; sever hypercalcemia associated to sever hypokalemia causing cardiac arrhythmia requiring an urgent hemodialysis. The evolution was marked with the death of the patient due to a paraneoplasic syndrome.
Conclusion: 
Richter’s syndrome has a very bad prognosis , it refers to the development of aggressive non-Hodgkin's lymphoma (NHL) during the course of chronic lymphocytic leukaemia (CCL). It occurs in approximately 3% of patients with CLL. The isolated form of this complication in bone is extremely rare and,
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