Silent Breakdown: Spontaneous Tumor Lysis Syndrome in Diffuse Large B Cell Lymphoma

Le résumé fourni par la source

Abstract Introduction:Tumor lysis syndrome (TLS) is a life-threatening, oncologic emergency where there is a large cell turnover causing rapid cell lysis. This leads to electrolyte derangements such as hyperphosphatemia, hyperuricemia and hyperkalemia. This is often seen in hematologic malignancies, but can also be seen in solid tumors. Commonly, TLS is triggered by chemotherapy, but in rare cases, spontaneous TLS can be seen in treatment-naive patients. We present the case of a 70 year old male with Stage IIIB diffuse large B cell lymphoma who presented with spontaneous TLS. Case Presentation:Patient had a past medical history of newly diagnosed Stage IIIB diffuse large B cell lymphoma who presented to emergency department with complaints of chest pain and shortness of breath. On arrival, patient had Blood pressure 64/44 mm hg and hypoxia requiring oxygen support. Laboratory values were significant for multiple electrolyte abnormalities: hyperkalemia with serum potassium of 8, acute kidney injury with serum Creatinine/Blood Urea Nitrogen of 9.61/141, anion gap of 24, Phosphorus of 8.8, uric acid of 18.1, lactate of 3.67 and lactate dehydrogenase of 4000, thrombocytopenia with platelet count of 40,000, bandemia (19% of total leukocyte count). A diagnosis of spontaneous tumor lysis syndrome was made, aggressive hydration was initiated followed by rasburicase along with mannitol. Given the patient's acute kidney injury and hyperkalemia, the patient was started on conventional hemodialysis followed by continuous renal replacement therapy (CRRT). Patient was transferred to the medical intensive care unit for strict monitoring of electrolytes and significant hypotension requiring pressor support. Rituximab was initiated on the third day of hospitalization followed by a 50% reduced dosage regimen of cyclophosphamide, doxorubicin, prednisone and vincristine. Allopurinol was administered every alternate day. CRRT was continued throughout the chemotherapy with strict monitoring of renal recovery and serum electrolytes. Discussion: Patients with TLS are admitted to the intensive critical care unit as electrolyte abnormalities can cause arrhythmias and seizures, requiring close monitoring. Tubule crystallization results in acute kidney injury. Treatment includes aggressive hydration with intravenous fluids, allopurinol and rasburicase, as well as hemodialysis in advanced renal disease. In our patient, he was recently diagnosed with a high grade lymphoma, with high cell turnover, prior to initiating chemotherapy. It is crucial to maintain TLS as a differential diagnosis in patients with malignancies presenting with electrolyte derangements, elevated uric acid and acute kidney injury, regardless of chemotherapy initiation.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.