Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report
Acute leukemia is the commonest pediatric malignancy with acute lymphoblastic leukemia (ALL) constituting about 75% of all leukemias. ALL commonly presents as fever, bleeding, bone pains, anemia, lymphadenopathy and hepatosplenomegaly. The liver, spleen or lymph nodes are the most common sites of e...
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Hacettepe University Institute of Child Health
2019-02-01
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| Series: | The Turkish Journal of Pediatrics |
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| Online Access: | https://turkjpediatr.org/article/view/657 |
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| author | Shilpa Khanna Arora Swarnim Swarnim Alok Hemal Neha Bidhuri |
| author_facet | Shilpa Khanna Arora Swarnim Swarnim Alok Hemal Neha Bidhuri |
| author_sort | Shilpa Khanna Arora |
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Acute leukemia is the commonest pediatric malignancy with acute lymphoblastic leukemia (ALL) constituting about 75% of all leukemias. ALL commonly presents as fever, bleeding, bone pains, anemia, lymphadenopathy and hepatosplenomegaly. The liver, spleen or lymph nodes are the most common sites of extramedullary involvement in ALL, with renal involvement being relatively uncommon. The usual differential diagnosis of acquired massive bilateral nephromegaly in children includes pyelonephritis, obstructive uropathy, infections such as HIV nephropathy, mucormycosis, glycogen storage diseases, myelofibrosis with extramedullary hematopoiesis, kidney tumors and rarely hematological malignancies like ALL. Here we report a 2 years old child who presented with abdominal distention, low grade fever and constipation. Clinical examination revealed massive bilateral nephromegaly. Preliminary investigations showed severe anemia and slightly elevated WBC counts with presence of reactive changes in lymphocytes along with few atypical cells (9%). Abdominal ultrasonography revealed bilaterally enlarged kidneys which was later confirmed by CT abdomen. He was eventually diagnosed with CALLA positive B cell ALL for which treatment was started in accordance with the International network for cancer treatment and research (INCTR) protocol 02 04. At present, he is on maintenance phase and responding well to the treatment with regression of kidney size to normal on follow up ultrasonogram. Thus, leukemia should be considered in a child presenting with bilateral nephromegaly after exclusion of above mentioned differential diagnosis. Bone marrow aspiration must be done before doing a more invasive investigation like renal biopsy.
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| format | Article |
| id | doaj-art-193c64c1f3c04b048a7f2f04aef4ede0 |
| institution | OA Journals |
| issn | 0041-4301 2791-6421 |
| language | English |
| publishDate | 2019-02-01 |
| publisher | Hacettepe University Institute of Child Health |
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| series | The Turkish Journal of Pediatrics |
| spelling | doaj-art-193c64c1f3c04b048a7f2f04aef4ede02025-08-20T02:01:47ZengHacettepe University Institute of Child HealthThe Turkish Journal of Pediatrics0041-43012791-64212019-02-0161110.24953/turkjped.2019.01.015Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case reportShilpa Khanna Arora0Swarnim Swarnim1Alok Hemal2Neha Bidhuri3Department of Pediatrics, Post Graduate Institute of Medical Education & Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India.Department of Pediatrics, Post Graduate Institute of Medical Education & Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India.Department of Pediatrics, Post Graduate Institute of Medical Education & Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India.Department of Pediatrics, Post Graduate Institute of Medical Education & Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India. Acute leukemia is the commonest pediatric malignancy with acute lymphoblastic leukemia (ALL) constituting about 75% of all leukemias. ALL commonly presents as fever, bleeding, bone pains, anemia, lymphadenopathy and hepatosplenomegaly. The liver, spleen or lymph nodes are the most common sites of extramedullary involvement in ALL, with renal involvement being relatively uncommon. The usual differential diagnosis of acquired massive bilateral nephromegaly in children includes pyelonephritis, obstructive uropathy, infections such as HIV nephropathy, mucormycosis, glycogen storage diseases, myelofibrosis with extramedullary hematopoiesis, kidney tumors and rarely hematological malignancies like ALL. Here we report a 2 years old child who presented with abdominal distention, low grade fever and constipation. Clinical examination revealed massive bilateral nephromegaly. Preliminary investigations showed severe anemia and slightly elevated WBC counts with presence of reactive changes in lymphocytes along with few atypical cells (9%). Abdominal ultrasonography revealed bilaterally enlarged kidneys which was later confirmed by CT abdomen. He was eventually diagnosed with CALLA positive B cell ALL for which treatment was started in accordance with the International network for cancer treatment and research (INCTR) protocol 02 04. At present, he is on maintenance phase and responding well to the treatment with regression of kidney size to normal on follow up ultrasonogram. Thus, leukemia should be considered in a child presenting with bilateral nephromegaly after exclusion of above mentioned differential diagnosis. Bone marrow aspiration must be done before doing a more invasive investigation like renal biopsy. https://turkjpediatr.org/article/view/657acute lymphoblastic leukemiakidneynephromegaly |
| spellingShingle | Shilpa Khanna Arora Swarnim Swarnim Alok Hemal Neha Bidhuri Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report The Turkish Journal of Pediatrics acute lymphoblastic leukemia kidney nephromegaly |
| title | Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report |
| title_full | Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report |
| title_fullStr | Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report |
| title_full_unstemmed | Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report |
| title_short | Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report |
| title_sort | acute lymphoblastic leukemia presenting as nephromegaly in a child a rare case report |
| topic | acute lymphoblastic leukemia kidney nephromegaly |
| url | https://turkjpediatr.org/article/view/657 |
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