Don’t let a chain of incidences, conceals the truth

مقدمه/ بیان مساله : Renal involvement has been documented in the literature as a manifestation of non-Hodgkin's lymphoma, but NHL rarely presents with bilateral hydronephrosis and subsequent acute kidney injury (AKI). we discuss the manifestation of aggressive NHL in a very young patient whose first and only manifestation was AKIمعرفی بیمار : A ۲۰-year-old male patient was admitted to the emergency department due to shortness of breath, bloody diarrhea, and abdominal and chest pain. six days ago he was underwent transurethral lithotripsy (TUL) due to bilateral hydroneohrosis and typical symptoms of urethral stone. According to friction rub and dull percussion and subjective shortness of breath, a chest X-ray revealed a non-massive pleural effusion. the patient underwent thoracentesis, and the fluid sample was sent to the laboratory for analysis; turbid fluid containing ۱۳۳۴۶ white blood cells (with ۸۴% lymphocyte) and ۱۱۰۰۰ red blood cells, protein ۳.۵g/dl with fluid protein /serum protein ۰.۹. Moderate amount of ascites was also encountered which was sampled and sent to laboratory. Pleural fluid adenosine deaminase (ADA) was ۵۰. According to anuria, blood urea nitrogen and creatinine levels, ascites and friction rub, patient undergone dialysis via Shaldon catheter. Despite IV antibiotic therapy, leukocytosis didn’t subside. The next day, abdominal pain and hematochezia worsened, and he underwent emergency laparotomy surgery due to a board-like abdomen in the abdominal examination. In surgery conglomeration of multiple small-bowel loops were observed. The surgeon takes a biopsy from the patient's intestine and omentum and sends it for pathology. Histopathological finding of surgical specimen denoted malignant lymphoma.

کلیدواژه ها:

non-Hodgkin lymphoma ، transurethral lithotripsy ، acute kidney injury