Bilateral massive nephromegaly-A rare presentation of t-cell acute lymphoblastic leukemia.

Abstract

INTRODUCTION:

Renal infiltration by leukemia causing massive bilateral nephromegaly is an extremely rare presentation of T-cell acute lymphoblastic leukemia(T-ALL).

CASE REPORT:

18-month-old female toddler presented with fever and progressive abdominal distension of 4-6 weeks duration. Imaging revealed bilateral massively enlarged kidneys with normal excretion. Peripheral blood counts and smear examination was unremarkable and immunophenotypic evaluation of marrow was consistent with T-ALL. Chest imaging was unremarkable. She was started on modified Indian Childhood Collaborative Leukemia Group (ICiCLe) ALL protocol. Even with the best anti-tumor lysis syndrome (TLS) prophylaxis the child required two sessions of hemodialysis. An end-induction morphological remission & end-consolidation negative minimal residual disease (MRD) could be achieved.

CONCLUSION:

Bilateral massive nephromegaly is an extremely rare presentation of T-ALL. This case emphasizes the unusual presentation, need for prompt remediation of TLS, and most importantly the use of early intensification with four drug anthracycline & dexamethasone-based therapy for the treatment of T-ALL in children.

• Authors: Kalasekhar Vijayasekharan, Vasudeva Bhat K, Archana M Venkatagiri, Vishwapriya M Godkhindi, Sindhura Lakshmi Koulmane Laxminarayana, Sushma Belurkar
• Journal: Leukemia research reports (Leuk Res Rep) Vol. 15 Pg. 100246 ( 2021) ISSN: 2213-0489 [Print] England
• PMID: 34113542 (Publication Type: Case Reports)
• Copyright: © 2021 The Authors. Published by Elsevier Ltd.