SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Tumor Lysis Syndrome in Undiagnosed Diffuse Large B-Cell Lymphoma

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This case describes spontaneous tumor lysis syndrome (TLS) in an 81-year-old man with previously undiagnosed diffuse large B-cell lymphoma and a history of heart failure. Spontaneous TLS is rare, with an incidence reported as low as 1.8%, but it can be life-threatening because it causes severe metabolic disturbances that may lead to arrhythmias, renal failure, seizures, and death.<br /><br />The patient presented with acute kidney injury and laboratory abnormalities consistent with Cairo-Bishop laboratory TLS, including elevated uric acid, hyperkalemia, hyperphosphatemia, and hypocalcemia. Clinical TLS is defined by these lab findings plus complications such as creatinine rise, cardiac arrhythmia, or seizure. Imaging showed multiple enlarged mesenteric lymph nodes, a large ileocecal mass extending into pericolonic fat, and moderate ascites, supporting an underlying malignancy.<br /><br />The report emphasizes that spontaneous TLS should be considered even when there has been no exposure to cytotoxic therapy and even when the suspected cancer is not a hematologic malignancy. Early recognition is critical. Prompt treatment of electrolyte abnormalities, hyperuricemia, and renal dysfunction can reduce complications. Rasburicase is preferred over allopurinol for lowering uric acid, and renal replacement therapy is indicated if metabolic abnormalities or renal failure do not respond to medical management.<br /><br />Overall, the case highlights the need to include spontaneous TLS in the differential diagnosis of patients with possible malignancy who present with acute kidney injury and characteristic biochemical changes.

Asset Subtitle

Yu-Han Chen

Meta Tag

Author List Chadane Thompson, Meghan Kaumaya, Natasha Rastogi, Osman Abdelsadig, Vikas Akkaraju, Yu-Han Chen

Category Clinical Vignettes

Concept Tumor Lysis Syndrome

Concept Spontaneous Tumor Lysis Syndrome

Concept Malignancy

Concept Acute Kidney Injury

Concept Rasburicase

Distinguished Non-Finalist

Presenter Organization Department of Internal Medicine, Englewood Hospital and Medical Center

Presenting Author Yu-Han Chen

Track Adult

Keywords

spontaneous tumor lysis syndrome

diffuse large B-cell lymphoma

acute kidney injury

hyperuricemia

hyperkalemia

hyperphosphatemia

hypocalcemia

Cairo-Bishop criteria

rasburicase

renal replacement therapy

Tumor Lysis Syndrome

Spontaneous Tumor Lysis Syndrome

Malignancy

Acute Kidney Injury

Rasburicase