A 4-month-old girl, born at term, with adequate weight for gestational age, with no relevant personal or family history.
She consulted due to food refusal and fever of 48 hours of evolution.
It is derived from a general hospital with suspected sepsis to urinary focus.
On physical examination, as positive data, the patient was alert, irritable, febrile, hypertensive and had bilateral abdominal masses.
Physical examination was normal.
Abdominal ultrasound was performed: right kidney: 86 x 41 mm; left kidney: 87 x 44 mm (values above the normal upper limit); there was an increase in echogenicity and size of the parenchyma compatible with hypoechoic images.
The medullary area is well differentiated, without local foot dilatation.
Laboratory: hematocrit 14%, hemoglobin 5.5 g/dl, platelets 36,000/mm3, white blood cells 3,500/mm3 (83% lymphocytes), creatinine 0.8 mg/dl, urea 20 mg/dl, GPT 68 U/dl abnormal sediment.
Urocultiva was negative.
TAC is performed: liver, spleen and pancreas nor-males, both ortotopic kidneys, markedly enlarged, show contrast enhancement and elimination.
No retroperitoneal adenomegaly or free fluid in the abdominal cavity was observed.
Pelvis within normal limits.
1.
With suspicion of onchohematologic disease it was decided to perform puncture aspiration of bone marrow that gives insufficient material.
It was decided to perform a renal biopsy and, in the same surgical procedure, bone marrow puncture, after which ALL was diagnosed with 68% blasts in bone marrow, without blasts in peripheral blood.
Morphology FAB: ALL L2.
Immunophenotype: ALL pro-B: + TdT and CD19.
After diagnosis, an INTERFAN 2006 chemotherapy protocol was started, with good response in peripheral blood on the eighth day, as well as in bone marrow on the fifteenth day.
Currently, renal ultrasound and laboratory values are normal and the time to remission at the time of communication is 7 months.
