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| Year : 2010 | Volume
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| Issue : 5 | Page : 959-960 |
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| Hypercalcemia with renal failure in a patient with immunoblastic variant of non-hodgkins lymphoma of the bone |
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V Sivakumar1, C Krishnakishore1, P Sriramnaveen1, G Sivaramakrishna1, B Vijayalakshmi Devi2, AY Lakshmi2, M Kumaraswamy Reddy3
1 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India
2 Department of Radiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India
3 Department of Pathology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, India
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| Date of Web Publication | 31-Aug-2010 |
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How to cite this article:
Sivakumar V, Krishnakishore C, Sriramnaveen P, Sivaramakrishna G, Devi B V, Lakshmi A Y, Reddy M K. Hypercalcemia with renal failure in a patient with immunoblastic variant of non-hodgkins lymphoma of the bone. Saudi J Kidney Dis Transpl 2010;21:959-60 |
How to cite this URL:
Sivakumar V, Krishnakishore C, Sriramnaveen P, Sivaramakrishna G, Devi B V, Lakshmi A Y, Reddy M K. Hypercalcemia with renal failure in a patient with immunoblastic variant of non-hodgkins lymphoma of the bone. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 Oct 30];21:959-60. Available from: https://www.sjkdt.org/text.asp?2010/21/5/959/68904 |
To the Editor,
Hypercalcemia with renal failure in a patient with the immunoblastic variant of non-Hodgkins lymphoma is rare. We herewith report on an elderly male patient who presented to us with recent onset generalized weakness, easy fatigability, diffuse myalgia and bone pains. In the recent past, he was evaluated elsewhere in a nephrology facility for similar symptoms and was found to have mild renal failure, hypercalcemia and tested normal for serum protein electrophoresis with a renal biopsy showing focal and segmental glomerulosclerosis and no cast nephropathy. In our evaluation, he was emaciated in appearance, with pedal edema, and diffuse bony tenderness, predominantly over lumbosacral spine and pelvic bones and no significant lymphadenopathy. Laboratory evaluation revealed anemia [hemoglobin (Hb) 8.1 gm/dL, PCV, 23%)] and raised ESR (102 mm/1 st hour), significant proteinuria (4.5 gm/day), absent urinary bence jones protein, 24-hour urinary calcium and phosphorous of 50 mg and 414 mg respectively and benign urinary sediment. He had renal failure (blood urea: 42 mg/dL, serum creatinine: 3.6 mg/dL), hyponatremia (125 mEq/L), hypokalemia (2.8 mEq/L), hypercalcemia (corrected, 12.8 mg/dL), hypoalbuminemia (serum albumin 3.1 gm/L) and normal serum phosphorus (2.4 mg/dL). He tested negative for HBsAg, anti-HCV and anti-retroviral serology by ELISA technique. Ultrasound abdomen showed normal sized kidneys with diffuse increased echogenicity and mild prostatomegaly. Computerized tomographic (CT) scan of the brain showed old lacunar infarct in the right lentiform nucleus area. CT scan of the abdomen revealed multiple osteolytic areas in the lower lumbar and sacral regions and in the iliac bones bilaterally [Figure 1]. CT guided fine needle aspiration cytology (FNAC) from the affected iliac bone revealed the presence of binucleated immature cells suggesting the possibility of immunoblastic lymphoma. Bone marrow examination showed mild megaloblastic changes. During his hospital stay, he received adequate hydration and correction of the electrolyte abnormalities. He did not receive bisphosphonates. The patient achieved significant clinical improvement with this treatment. Also, the serum creatinine came down to 2.4 mg/dL. Subsequently, the patient left the facility at request and did not come for follow-up. | Figure 1 :Plain CT scan of the pelvis showing lytic lesion in the right iliac blade with soft tissue component.
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Immunoblastic lymphoma is a malignant disorder of B-cells. It is a subtype of non-Hodgkins lymphoma accounting for 30-40% of individuals. It occurs in middle or old age-group. The presentation may be nodal or extra-nodal, the extra-nodal sites being the gastrointestinal tract, bone, testis and central nervous system. Immunocompromized individuals constitute the high-risk group. [1],[2] The most common causes of hypercalcemia in hospitalized patients are malignancies such as non-small cell carcinoma of the lung, squamous cell tumors, renal cell carcinoma, T or B cell lymphomas, hepatoma and melanoma. Other causes include primary hyperparathyroidism, hyperthyroidism, hypervitaminoses A and D, thiazide diuretics, prolonged immobilization, granulomatous diseases, familial hypocalciuric hypercalcemia and Paget's disease. [3] The reported mechanisms underlying hypercalcemia in pregnancy include PTHrP (PTH-related protein), calcitriol production and cytokine mediated. [3]
In conclusion, this patient presented with hypercalcemia related renal failure secondary to immunoblastic variant of non-Hodgkin's lymphoma in bone, a rare entity.
 References | |  |
| 1. | Gonzalez-Bonet LG, Gatierrez-Herrera JM, Gallego JM, Barcia JA. Primary immunoblastic B cell Lymphoma of the cranial vault. Acta Neurochir 2008;150:507-8.  |
| 2. | Takasaki H, Kanamori H, Takabayashi M, et al. Non hodgkins lymphoma presenting as multiple bone lesions and hypercalcemia. Am J Hematol 2006;81(6):439-42. |
| 3. | Kremer R, Shustik C, Tabak T, Papavasiliou V, Goltzman D. Parathyroid hormone related peptide in hematologic malignancies. Am J Med 1996;100(4):406-11. |
Correspondence Address:
V Sivakumar
Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati
India
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PMID: 20814144 
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