Журнал клинических случаев

Coexisting B- Cell Lymphoma and Benign Mesenchymal Phospaturic Tumor: Debut as Acute Renal Failure Associated with Hypercalcemia and Hypophosphatemia

Abstract

Navas-Parejo AMC, Ortega MP*, Molina MC, Terán CMB and Soto JB

The present case starts as an acute renal failure related to severe hypercalcemia, hypophosphatemia, increased FGF-23 and decreased TRP. All the previous are associated with increased bone exchange rate, low PTH, undetectable levels of PTH-RP, 1-25 OH Vitamin D3 in upper level of normal range and bone densitometry compatible with osteoporosis in trabecular bone. These results seem compatible with an increase in bone resorption, urinary loss of calcium and phosphate, and none induced by PTH. Complementary studies suggest the spleen is the organ directly related with this case. In conclusion, a B Cell Lymphoma was diagnosed. It explained the causes of the hypercalcemia, either by the effect of a lymphotoxin, TNF or interleukin 1. After total remission of the lymphoma, the hypophosphatemia persisted, as did the Hight levels of FGF-23, low levels of TPR and a pathological bone densitometry. This lead us to believe in the presence of a phosphatizing producer tumor located in the spleen. Once the splenectomy was done, the analytical findings returned to normal and the histologic evidence confirmed the initial clinical prediction.