DOI: 10.12890/2026_006944

Isolated bilateral nephromegaly as the initial presentation of acute lymphoblastic leukaemia: a rare case and review of the literature

Authors

  • Rawan Hamdan Department of Hematology, Al-Mouwasat University Hospital, Damascus, Syria
  • Mais Musleh Department of Hematology, Al-Mouwasat University Hospital, Damascus, Syria 0000-0002-2148-2921
  • Mahmoud Alhamadeh Alswij Department of Internal Medicine, Hematology Department, Al Mouwasat University Hospital, Damascus, Syria 0000-0003-0607-0889
  • Yara Ibraheem Department of Nephrology, Al-Mouwasat University Hospital, Damascus, Syria
  • Miriam Laflouf Department of Hematology, Al-Mouwasat University Hospital, Damascus, Syria 0009-0005-7902-0956
  • Abdulhalim Mohamed Alyousef Department of Hematology, National University Hospital, Damascus, Syria

Rawan.h.rh31@gmail.com

Keywords

Kidney infiltration, acute lymphoblastic leukaemia

Abstract

Introduction: Acute lymphoblastic leukaemia (ALL) is an aggressive hematologic malignancy, with T-cell ALL (T-ALL) accounting for approximately 25% of adult cases. Renal infiltration is recognized but rarely presents as isolated bilateral nephromegaly with acute kidney injury (AKI) in adults.
Case description: A 32-year-old previously healthy man presented with progressive bilateral flank pain, abdominal heaviness, fatigue, intermittent fever, night sweats, and unintentional weight loss. Physical examination revealed large bilateral flank masses without peripheral lymphadenopathy. Laboratory tests initially showed normal blood counts but significant renal impairment (creatinine 3.5 mg/dl, urea 82 mg/dl). Imaging demonstrated massive bilateral kidney enlargement (~20 × 20 cm). Percutaneous renal biopsy revealed diffuse infiltration by medium-sized lymphoblasts expressing CD3 and TdT, confirming T-ALL. Within 1-week, hematologic abnormalities developed, including leucocytosis, anaemia, and thrombocytopenia, alongside worsening renal function and tumour lysis syndrome, necessitating dialysis and allopurinol therapy. The patient was started on a pre-phase corticosteroid regimen followed by intensive hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin [Adriamycin], and dexamethasone) induction chemotherapy. Initial radiologic improvement occurred; however, the clinical course was complicated by neutropenic sepsis, ultimately resulting in death.
Conclusion: This case highlights a rare adult presentation of T-ALL in which renal involvement preceded hematologic abnormalities. Clinicians should consider hematologic malignancy in adults presenting with unexplained bilateral nephromegaly and AKI, even if initial blood counts are normal. Early recognition and timely intervention are critical to improve renal and overall outcomes.

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References

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Published

2026-07-09

Issue

Vol. 13 No. 7 (2026)

Categories

How to Cite

1.
Hamdan R, Musleh M, Alhamadeh Alswij M, Ibraheem Y, Laflouf M, Mohamed Alyousef A. Isolated bilateral nephromegaly as the initial presentation of acute lymphoblastic leukaemia: a rare case and review of the literature. EJCRIM [Internet]. 2026 Jul. 9 [cited 2026 Nov. 3];13(7). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6944

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