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

Kalasekhar Vijayasekharan; Vasudeva Bhat K; Archana M Venkatagiri; Vishwapriya M Godkhindi; Sindhura Lakshmi Koulmane Laxminarayana; Sushma Belurkar

doi:10.1016/j.lrr.2021.100246

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

Leuk Res Rep. 2021 May 19:15:100246. doi: 10.1016/j.lrr.2021.100246. eCollection 2021.

Authors

Kalasekhar Vijayasekharan¹, Vasudeva Bhat K¹, Archana M Venkatagiri¹, Vishwapriya M Godkhindi², Sindhura Lakshmi Koulmane Laxminarayana², Sushma Belurkar²

Affiliations

¹ Division of Pediatric Hematology Oncology, Manipal comprehensive cancer care centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
² Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.

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.

Keywords: Acute lymphoblastic leukemia; Bilateral nephromegaly; Renal leukemic infiltration.

Publication types

Case Reports