Diffuse lymphomatous infiltration of kidney presenting as renal tubular acidosis and hypokalemic paralysis: case report.
We report the case of a 22-year-old woman who presented with acute onset flaccid quadriparesis. Physical examination showed mild pallor with cervical and axillary lymphadenopathy, hepatomegaly, and bilateral smooth enlarged kidneys. Neurological examination revealed lower motor neuron muscle weakness in all the four limbs with hyporeflexia and normal sensory examination. Laboratory investigations showed anemia, severe hypokalemia, and metabolic acidosis. Urinalysis showed a specific gravity of 1.010, pH of 7.0, with a positive urine anion gap. Ultrasound revealed hepatosplenomegaly with bilateral enlarged smooth kidneys. Renal biopsy was consistent with the diagnosis of non-Hodgkin lymphoma (B cell type). Metabolic acidosis, alkaline urine, and severe hypokalemia due to excessive urinary loss in our patient were suggestive of distal renal tubular acidosis. Renal involvement in lymphoma is usually subclinical and clinically overt renal disease is rare. Diffuse lymphomatous infiltration of the kidneys may cause tubular dysfunction and present with hypokalemic paralysis.
Jhamb
Rajat
R
Maulana Azad Medical College, 110002 New Delhi, India.
Gupta
Naresh
N
Garg
Sandeep
S
Kumar
Sachin
S
Gulati
Sameer
S
Mishra
Deepak
D
Beniwal
Pankaj
P
D000136:Acid-Base Equilibrium; D000141:Acidosis, Renal Tubular / Q000209:etiology* / Q000473:pathology; D000328:Adult; D018941:Antigens, CD19 / Q000378:metabolism; D018951:Antigens, CD20 / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006529:Hepatomegaly / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007008:Hypokalemia / Q000188:drug therapy / Q000209:etiology*; D007668:Kidney / Q000000981:diagnostic imaging / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis*; D018908:Muscle Weakness / Q000209:etiology; D010243:Paralysis / Q000209:etiology*; D011189:Potassium Chloride / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011859:Radiography; D013163:Splenomegaly / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome; D014463:Ultrasonography; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use
D018941:Antigens, CD19; D018951:Antigens, CD20; D014750:Vincristine; D011189:Potassium Chloride; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone