A 17-year-old female, without medical history, presented with a 15-day history of diplopia, nasal obstruction, and left orbital pain, associated with fever and night sweats. The physical examination found a left exophthalmos and bilateral cervical lymphadenopathy. T2-weighted orbital magnetic resonance imaging showed a left soft-tissue mass slightly hyperintense compared to muscle involving intra- and extraconal space responsible for an exophthalmos, with an extension to the left ethmoid sinus and the left nasal fossa. Biopsy of the nasal mass and histopathologic examination objectified a high-grade DLBCL (CD20+, Bcl2+, CD3-, and CD5-, with a Ki-67 proliferation index of 95%). In addition, the cerebrospinal fluid analysis was consistent with a central nervous system (CNS) involvement.\nBaseline18F-FDG PET/CT revealed intense18F-FDG uptake throughout the bilaterally enlarged renal parenchyma, on the soft tissue in the left orbit extending into the left nasal cavity, and on cervical and abdominal lymph nodes. Peritoneal nodules with diffusely increased18F-FDG and multiple hypermetabolic bones foci, including humeri, ribs, and pelvis uptake were also noted []. After 4 cycles of dose-adjusted EPOCH-rituximab, the patient was referred for18F-FDG PET/CT for response evaluation. The18F-FDG PET/ CT showed a total regression of renal lesions suggesting good response to therapy [].
A 75-year-old man with stage IV CKD on a background of previously poorly controlled type 2 diabetes mellitus (T2DM) was reviewed in his routine renal outpatient appointment. His renal function had been slowly worsening for the past 2 years; however, on this occasion a marked increase in creatinine and proteinuria was noted despite excellent blood glucose control during the preceding 6 months, with an average glycated haemoglobin (HbA1c) of 5% ().\nApart from the T2DM complicated by neuropathy and nephropathy, his past medical history also included hypertension.\nHe was compliant with all of his medications with no significant recent medication changes and his regular medications included gliclazide, moxonidine, telmisartan/amlodipine, oral iron sulfate and vadadustat (an oral prolyl hydroxylase inhibitor).\nHe was an ex-smoker having smoked during his teenage years and he consumed less than 3 units of alcohol/week.\nThere was no family history of renal disease or haematological malignancies.\nExamination revealed moderate lymphadenopathy in the left cervical region. There was no other peripheral lymphadenopathy and no hepatosplenomegaly. The remainder of the examination was normal.\nPlans for renal replacement therapy were made, including commencement of work-up to determine suitability for renal transplantation and to investigate the lymphadenopathy. A subsequent CT of his abdomen revealed extensive lymphadenopathy. Due to progressive fluid overload and worsening biochemical parameters, he was commenced on haemodialysis.