Document Type : Case Report(s)

Authors

• Mohammadreza Bordbar ¹
• Nader Shakibazad ^{1, 2}
• Hadi Mottaghipisheh ³
• Mahdi Shahriari ³
• Soheila Zareifar ¹
• Omid Reza Zekavat ¹

¹ Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

² Department of Pediatric Hematology and Oncology, Bushehr University of Medical Sciences, Bushehr, Iran

³ Department of Pediatrics, Division of Pediatric Hematology and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Acute lymphoblastic leukemia has several presentations associated with bone marrow and extramedullary involvement. The unusual presentation may be due to the infiltration of leukemic cells in any organ. An 11-year-old girl presented with fever and vomiting, since one day before admission after starfish biting during swimming. Her vital signs were: blood pressure 150/100 mmHg, pulse 98 beats per minute, respiration 18 breathes per minute, and temperature 37.2 °C (99 F). Laboratory work-up showed blood urea nitrogen 38 mg/dl and creatinine 2.8 mg/dl. In peripheral blood smear, few atypical cells, mild anemia (Hb: 9.2 g/dl), and mild thrombocytopenia (Platelet: 109,000/μL) were detected. Bone marrow aspiration and immunophenotyping were in favor of acute precursor B cell type lymphoblastic leukemia. The patient had a favorable response to treatment after initiating high-risk chemotherapy. Therefore, acute renal failure can be a rare initial presentation of acute lymphoblastic leukemia, and azotemia will improve with an early chemotherapy treatment.

Keywords

• Renal failure
• Acute lymphocytic leukemia
• Precursor B-cell lymphoblastic leukemia
• Azotemia