Bilateral Nephromegaly and Spontaneous Tumor Lysis Syndrome as an Initial Manifestation of Pre-T Acute Lymphoblastic Leukemia: Case Report and Review of the Literature.

Abstract Background Acute lymphoblastic leukemia is relatively rare in adults and kidney manifestations are extremely infrequent. Acquired bilateral nephromegaly is a rare condition with many differential diagnoses. We describe the case of a patient with bilateral nephromegaly and spontaneous tumor lysis syndrome secondary to pre-T ALL, who required renal replacement therapy with recovery of renal function following treatment. Case presentation: A 29-year-old man with an unintentional weight loss of 15 kilograms approximately, intermittent fever (one to two episodes per month), right flank pain radiating to the ipsilateral inguinal region, hyporexia and fatigue. An abdominal ultrasound revealed splenomegaly of 15.7 cm and bilateral nephromegaly (right kidney 144 x 105 x 88 mm and left kidney 143 x 82 x 60 mm). After an extensive approach, etiologies like tuberculosis, human immunodeficiency virus infection, hepatitis B, hepatitis C, toxoplasmosis, cytomegalovirus, herpes virus, and Epstein-Barr were excluded. After retroperitoneal lymph node biopsy, pre-T acute lymphoblastic leukemia and also a spontaneous tumor lysis syndrome were diagnosed. After chemotherapy there was improvement and he presented decrease in renal size is observed by imaging study. Conclusion The association between nephromegaly with pre-T acute lymphoblastic leukemia and spontaneous tumor lysis syndrome is very rare. In these cases, a multidisciplinary and integrated approach is required to improve outcomes, especially in terms of disease-free survival and recovery of renal function.