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Acute lymphoblastic leukemia presenting as nephromegaly in a child: A rare case report

机译:急性淋巴母细胞白血病表现为儿童肾肿大:罕见病例报告

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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.
机译:急性白血病是最常见的小儿恶性肿瘤,其中急性淋巴细胞白血病(ALL)约占所有白血病的75%。 ALL通常表现为发烧,出血,骨痛,贫血,淋巴结肿大和肝脾肿大。肝,脾或淋巴结是ALL中最常见的髓外受累部位,而肾脏受累相对较少。儿童获得性大面积双侧肾肿大的常见鉴别诊断包括肾盂肾炎,阻塞性尿毒症,HIV肾病,毛霉菌病,糖原贮积病,骨髓纤维化伴髓外造血,肾脏肿瘤以及很少有血液系统恶性肿瘤(如ALL)等感染。在这里,我们报告一个2岁的孩子,他患有腹胀,低度发烧和便秘。临床检查显示双侧大量肾肿大。初步调查显示,严重贫血和白细胞计数略高,淋巴细胞中有反应性改变,非典型细胞很少(9%)。腹部超声检查显示双侧肾脏增大,后来被CT腹部证实。最终他被诊断出患有CALLA阳性B细胞ALL,并且已根据国际癌症治疗和研究网络(INCTR)协议02 04开始对其进行治疗。目前,他处于维持阶段,并且对治疗的反应良好,并逐渐消退。超声检查肾脏大小正常。因此,排除上述鉴别诊断后,患有双侧肾肿大的儿童应考虑白血病。在进行更具侵入性的检查(如肾活检)之前,必须先进行骨髓抽吸术。

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