Beyond CKD-Associated Pruritus: Paraneoplastic Itch Revealing CLL/SLL in ESRD: A Case Report

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 (CKD-aP). 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.