Primary renal leukaemia in a young adult male as an extramedullary presentation of T cell acute lymphoblastic leukaemia.

Primary renal involvement by T lymphoblasts is rare among adults with T acute lymphoblastic leukaemia. We report a 28-year-old man presenting with acute renal failure due to infiltration by T lymphoblasts and his response to paediatric-inspired modified BFM-90 protocol. The patient achieved an initial complete remission (CR) but developed central nervous system relapse. He achieved CR2 with cranial irradiation and intrathecal chemotherapy. He underwent a haploidentical transplant in CR2 and remains in remission post-transplant day 330. An early kidney biopsy helped confirm the diagnosis. Such presentations remain responsive to modified BFM-90. An early allotransplant in CR2 remains the standard of care.

Rosuvastatin-Induced Rhabdomyolysis: A Case Report.

Rosuvastatin is a recently approved statin and used widely across the globe for primary and secondary prevention of atherosclerotic cardiovascular heart disease. It has the highest lipid-lowering property among all statins and relatively well tolerated. Rhabdomyolysis is a rare but potentially serious adverse effect. The present report highlights the case of a patient admitted with proximal myopathy with severe rhabdomyolysis and acute kidney injury associated with life-threatening hyperkalemia. The symptoms appeared within 1 month of starting rosuvastatin. He required temporary dialysis to overcome the crisis. His myopathy and kidney injury were completely reversible after a few months of stopping the drug. In this report, we have also discussed the various risk factors for developing myopathy with statins and the importance of strict pharmacovigilance, and a greater caution among physicians while using this drug.

Nephrobronchial fistula and lung abscess secondary to Xanthogranulomatous pyelonephritis.

There are multiple causes of lung abscess, but the differential rarely includes pyelonephritis as a primary cause leading to lung abscess resulting from the development of a nephrobronchial fistula. The patient had no urinary symptoms or abdominal pain and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.

Severe hypoglycemia with endogenous hyperinsulinemia in a nondiabetic hemodialysis patient following parathyroidectomy.

Insulin resistance and abnormal carbohydrate metabolism is a recognized complication in patients with advanced chronic kidney disease. We describe a rare case of severe hypoglycemia with inappropriate endogenous hyperinsulinemia in a hemodialysis patient following parathyroidectomy for severe secondary hyperparathyroidism. The patient required intravenous dextrose infusions for 3 days to prevent neuroglycopenic symptoms. Extensive workup for hypoglycaemia revealed high C-peptide and insulin levels in the absence of insulinoma. It is postulated that reversal of parathyroid hormone (PTH)-mediated inhibition of insulin secretion, along with large doses of 1,25-dihydroxyvitamin D3 (calcitriol) were responsible for the increase in insulin secretion and consequent hypoglycemia in this patient.