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A Rare Case of 18F-FDG-avid Renomegaly as the Initial Presentation of Acute Lymphoblastic Leukemia
Address for correspondence: Dr. Vineet Mishra, Department of Nuclear Medicine, Shatabdi Phase-2, King George’s Medical University, Lucknow - 226 003, Uttar Pradesh, India. E-mail: crystal.vineet@gmail.com
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Received: ,
Accepted: ,
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Acute lymphoblastic leukaemia (ALL) is a prevalent cause of paediatric leukaemia. Patients with ALL typically exhibit symptoms such as fever, bleeding, weight loss, and bone pain. Blood investigations results predominantly show anaemia and pancytopenia with blast cells in the peripheral smear. While ALL primarily affects the bone marrow, it can also impact nearly every organ. There have been previous reports of extramedullary involvement of multiple organs in cases of ALL. This case represents a rare occurrence of 18F-fluorodeoxyglucose (FDG) avid symmetrically enlarged kidneys as initial presentation of ALL.
Keywords
Acute lymphoblastic leukemia
leukemia
fluorodeoxyglucose positron emission tomography/computed tomography
A 13-year-old male adolescent, resident of North India, presented with a complaint of Fever for 3 months associated with chills and rigor. On investigations anaemia (Haemoglobin 9.2 g/dL) and raised S. Creatinine (1.7 mg/dL) were only appreciable abnormality. Leucocyte & platelet counts were within normal limits with normal peripheral blood smear. Ultrasonography of the abdomen revealed symmetrically enlarged bilateral kidneys. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed FDG avid enlarged bilateral kidneys with heterogeneous FDG avidity in the bone marrow [Figure 1]. Biopsy from the kidney was suggestive of B cell- Acute lymphoblastic leukaemia (ALL). ALL is one of the most common causes of paediatric leukaemia.[12] Patients with ALL usually present with fever, bruises with bleeding, weight loss and bone pain. On hemogram anaemia and pancytopenia with blast cell in peripheral smear are the usual findings. Although ALL predominantly involves bone marrow, it can involve almost every organ including the kidneys.[345] Extramedullary involvement of multiple organs in ALL has been reported previously.[67] This case represents a rare occurrence of FDG avid symmetrically enlarged kidneys as initial presentation of ALL.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest
There are no conflicts of interest.
Nil.
References
- Acute lymphoblastic leukemia: A comprehensive review and 2017 update. Blood Cancer J. 2017;7:e577.
- [Google Scholar]
- Acute renal failure as an initial manifestation of acute lymphoblastic leukemia. Indian J Nephrol. 2013;23:292-3.
- [Google Scholar]
- Extramedullary manifestations in acute lymphoblastic leukemia in children: A systematic review and guideline-based approach of treatment. Am J Blood Res. 2020;10:360-74.
- [Google Scholar]
- Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 2008;28:20-8.
- [Google Scholar]
- Extramedullary infiltration of acute lymphoblastic leukemia in multiple organs on FDG PET/CT. Clin Nucl Med. 2018;43:217-9.
- [Google Scholar]
- Extramedullary infiltration in multiple organs in a relapsed case of acute lymphoblastic leukemia on (18) F-fluorodeoxyglucose positron emission tomography. Indian J Nucl Med. 2020;35:355-7.
- [Google Scholar]