Beyond CKD-Associated Pruritus: Paraneoplastic Itch Revealing CLL/SLL in ESRD: A Case Report
Year: 2025
Type: article
Study design: Case Report
Abstract: Small leukocytic lymphoma/chronic leukocytic leukemia Symptoms: Dizziness • dyspepsia • lymphadenopathy • nausea • oedema • pruritus • weakness Clinical Procedure: Blood test • bone marrow biopsy • CT abdomen and pelvis • peritoneal dialysis • ultrasonography Specialty: Hematology • Nephrology Objective: Unknown etiology Background:Pruritus is common in chronic dialysis patients, usually due to metabolic imbalance, xerosis, or other cutaneous complications of chronic kidney disease (CKD), leading to a diagnosis of CKD-associated pruritus (CKD4P).When symptoms persist despite optimized dialysis, stable laboratory indices, and no dermatologic cause, alternative etiologies must be considered. Case Report:A 66-year-old man with end-stage renal disease (ESRD) of unknown origin, treated with peritoneal dialysis, developed progressive, treatment-resistant pruritus.Initially localized to the extremities without primary lesions, it was unresponsive to standard therapies.As the itch became generalized, systemic symptoms emerged, including fatigue, lower-extremity edema, and pancytopenia.Differential diagnoses were excluded.Pre-transplant abdominal CT revealed generalized lymphadenopathy and splenomegaly.A bone marrow biopsy confirmed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) by immunophenotyping.Due to ESRD and active malignancy, the patient was ineligible for chemotherapy or kidney transplantation; pruritus management remained conservative. Conclusions:Persistent pruritus in dialysis patients warrants reevaluation beyond CKD-aP, especially in those with unknown CKD etiology and hematologic abnormalities.Recognizing paraneoplastic itch as a potential early sign of malignancy can enable earlier diagnosis in high-risk populations.
Source: American Journal of Case Reports
DOI: 10.12659/ajcr.949787
Institution: Medical University of Lodz
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4416865204
FWCI:
Cites:
Cited by:
Related to: