Shilpa Khanna ARORA, Swarnim SWARNİM, Alok HEMAL, Neha BİDHURİ

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

Acute leukemia is the commonest pediatric malignancy with acute lymphoblasticleukemia (ALL) constituting about 75% of all leukemias. ALL commonlypresents as fever, bleeding, bone pains, anemia, lymphadenopathy andhepatosplenomegaly. The liver, spleen or lymph nodes are the most commonsites of extramedullary involvement in ALL, with renal involvement beingrelatively uncommon. The usual differential diagnosis of acquired massivebilateral nephromegaly in children includes pyelonephritis, obstructive uropathy,infections such as HIV nephropathy, mucormycosis, glycogen storage diseases,myelofibrosis with extramedullary hematopoiesis, kidney tumors and rarelyhematological 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 bilateralnephromegaly. Preliminary investigations showed severe anemia and slightlyelevated WBC counts with presence of reactive changes in lymphocytes alongwith few atypical cells (9%). Abdominal ultrasonography revealed bilaterallyenlarged kidneys which was later confirmed by CT abdomen.He was eventually diagnosed with CALLA positive B cell ALL for whichtreatment was started in accordance with the International network forcancer treatment and research (INCTR) protocol 02 04. At present, he is onmaintenance phase and responding well to the treatment with regression ofkidney size to normal on follow up ultrasonogram.Thus, leukemia should be considered in a child presenting with bilateralnephromegaly after exclusion of above mentioned differential diagnosis. Bonemarrow aspiration must be done before doing a more invasive investigationlike renal biopsy.

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