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Abstract: PO1914

A Case of Hemophagocytic Lymphohistiocytosis (HLH) due to Large B Cell Lymphoma with infiltration in the kidneys

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Gosalia, Kinjal, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Bashir, Khawaja Arsalan, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Bijol, Vanesa, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Introduction

Secondary HLH is a life-threatening manifestation of certain malignancies and prompt diagnosis is essential in preventing poor outcomes. Kidney involvement in Large B cell lymphoma is under-reported and diagnosis can be challenging in the absence of abnormal kidney function.

Case Description

A 55-year-old male with no significant history was admitted to our facility with worsening mental status. He had 2 prior hospitalizations at an outside facility where he was treated with steroids for a presumed auto-immune CNS syndrome and partial improvement in symptoms. Vitals signs were normal on arrival and he was non-verbal on exam with right sided weakness. Lumbar puncture was negative for infection or malignant cells on analysis. MRI brain showed contrast enhancing lesions. Hospital course was complicated by persistent fevers, a rise in Serum creatinine (Scr) to 1.5md/dl on day 4 of admission in addition to new worsening thrombocytopenia and evidence of ongoing hemolytic anemia. Urinalysis revealed hematuria, no proteinuria, few WBCs but no active sediment. Other lab parameters were relevant for LDH of 3000, Ferritin >3000, TG of 1171 and soluble IL-2 receptor level elevated at >33,000. Patient met clinical criteria for HLH with concerns over a thrombotic microangiopathy (TMA) related to HLH and therefore a kidney biopsy was performed which revealed a diffuse atypical lymphocytic interstitial infiltrate, consistent with large B-cell lymphoma. No evidence of TMA was seen. A bone marrow biopsy performed at the same time, confirmed diffuse large B cell lymphoma with pleomorphic features and extensive involvement. A diagnosis of HLH secondary to Large B-Cell Lymphoma with infiltration to the bone marrow & kidneys was made.The patient's clinical condition deteriorated, and continuous form of renal replacement therapy was started in ICU. Chemotherapy was initiated, however he remained critically ill with worsening lactic acidosis, multi-organ failure and ultimately expired from cardiopulmonary arrest.

Discussion

Malignancy associated HLH is a challenging diagnosis which is often misdiagnosed. Diffuse large B cell lymphoma infiltrating the kidney confers a poor prognosis and this case illustrates the utility of a kidney biopsy in early diagnosis of a diffuse lymphoproliferative disorder which can improve patient outcomes