SHM Converge Scientific Abstract ePoster Gallery-Unexpected Spontaneous Tumor Lysis Syndrome in Renal Cell Carcinoma

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This case describes a 49-year-old man with newly diagnosed metastatic renal cell carcinoma who developed spontaneous tumor lysis syndrome (STLS), a rare but life-threatening complication usually seen in hematologic cancers after chemotherapy. RCC is not typically associated with TLS because of its slower growth and relative resistance to treatment, making this presentation especially unusual.<br /><br />The patient presented with poor oral intake, fatigue, and confusion on the same day he received his first dose of nivolumab. Initial labs showed hyperkalemia, acute kidney injury, metabolic acidosis, elevated lactate, and markedly abnormal liver enzymes. CT imaging revealed a large right renal mass invading the liver and adrenal gland, along with gastric outlet obstruction.<br /><br />Within 24 hours, the patient rapidly deteriorated with worsening hyperkalemia, hyperphosphatemia, severe hyperuricemia, rising creatinine, and worsening acidosis, confirming STLS. He was treated with aggressive IV fluids, sodium bicarbonate infusion, rasburicase, and hemodialysis. Despite treatment, he developed oliguric renal failure and later an upper GI bleed causing hemorrhagic shock and atrial fibrillation with rapid ventricular response, requiring ICU transfer and vasopressor support. He was ultimately transitioned to comfort care.<br /><br />The case highlights that STLS in metastatic RCC, though rare, can be fatal if not recognized early. Its presentation may mimic sepsis or liver failure, delaying diagnosis. Clinicians should consider checking uric acid in patients with unexplained acute kidney injury and bulky malignancy. The report emphasizes the important role of hospitalists in identifying rare oncologic emergencies, coordinating urgent multidisciplinary care, and guiding goals-of-care discussions.

Asset Subtitle

Mubasher Jaffri

Meta Tag

Author List Madhav Patel, Marina Kovacevic, Mubasher Jaffri, Sibgutallah Imdad

Category Clinical Vignettes

Concept Tumor Lysis Syndrome

Concept Spontaneous Tumor Lysis Syndrome

Concept Hyperkalemia

Concept Acute Kidney Injury

Concept Hyperuricemia

Distinguished Non-Finalist

Presenter Organization University of Chicago- Endeavor Health

Presenting Author Mubasher Jaffri

Track Adult

Keywords

spontaneous tumor lysis syndrome

metastatic renal cell carcinoma

nivolumab

hyperuricemia

acute kidney injury

hyperkalemia

hemodialysis

rasburicase

oncologic emergency

hospitalist care

Tumor Lysis Syndrome

Spontaneous Tumor Lysis Syndrome

Hyperkalemia

Acute Kidney Injury

Hyperuricemia