Bilateral Nephromegaly Due to Acute Lymphoblastic Leukaemia in an African Male Child: A Case Report

Abstract

Background: Nephromegaly is the enlargement of the kidney(s). In children, common causes include polycystic kidney disease, hydronephrosis, nephroblastoma, lymphomas, glycogen storage disorders and rarely infiltration by leukaemic blast cells. Involvement of the kidneys may be indicative of advanced disease and could be associated with poor outcome.

Case-report: We report the case of a 34-month-old male from Cameroon in Central Africa who presented with abdominal distension, pain, and bilateral proptosis. Ultrasound imaging studies was in keeping with bilateral kidney enlargement. Fine needle aspiration (FNA) of the kidneys revealed blast cells infiltration, and bone marrow examination was confirmatory of Acute Lymphoblastic Leukaemia (ALL).

Conclusion: There was an initial response to chemotherapy with regression of proptosis and reduction of both kidney sizes sonographically, however, a relapse occurred during the maintenance phase of treatment with re-emergence of earlier presenting symptoms which led to death.

This case seeks to demonstrate a rare presentation of leukaemia and highlights the possibility of bilateral kidney involvement as an initial manifestation of ALL, which may also indicate a bad prognostic factor associated with poor outcome.