Concurrent acute spontaneous tumor lysis syndrome complicated with multiple organ failure in a patient with pre-existing undiagnosed lung cancer

Abstract

Acute kidney injury, a common complication associated with malignancy, occurs in various clinical situations for numerous reasons. Acute tumor lysis syndrome (TLS) is possibly the most significant cause of acute kidney injury in cancer patients, because it is fulminant at onset and associated with severe metabolic derangements. Acute spontaneous tumor lysis syndrome is rare and most of the related malignancies belong to hematologic malignancies but it has seldom been investigated as bulky or advanced metastatic non-hematologic malignancies. TLS comprises a clinical laboratory derangement of cellular metabolism which can lead to acute renal impairments, cardiac arrhythmia, seizures and patient demise. Prevention and treatment of tumor lysis syndrome depends on early recognition of at-risk patients, volume repletion and xanthin oxidase inhibitors. In addition, in patients with high risk tumor types, prophylactic use of rasburicase before chemotherapy is required. If dialysis is required, continuous modalities may be favored, particularly in patients with more severe TLS. This case report discusses a 79-year-old man with controlled Alzheimer's disease presented with picture of septic shock and multiorgan dysfunction (acute kidney injury, acute lung injury, acute brain injury) pulmonary suppuration in the right lung field due to aspiration pneumonia with infection-induced systemic inflammatory response (SIRS) was diagnosed. Further workup revealed lung cancer on chest CT scan. Antibiotic, respirator and hemodialysis treatment improved his condition but died several days later. Acute spontaneous TLS may present in association with infectious SIRS and multiple organ failure, the combination of which results in significant mortality.

Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature

“…Among factors related to high tumor burden, our data suggested that only metastatic disease, especially in the liver or lungs, significantly increases the likelihood of death due to STLS. Previous literature has proposed metastatic disease, especially in the liver, to be associated with an increased risk for TLS development [ 6 , 20 , 30 , 32 , 33 , 36 – 38 , 44 , 58 , 59 , 93 , 95 , 96 ]. This is thought to occur due to increased tumor burden resulting in high purine pools and mechanical compression by the lesions [ 6 , 32 , 93 , 95 ].…”

“…Previous literature has proposed metastatic disease, especially in the liver, to be associated with an increased risk for TLS development [ 6 , 20 , 30 , 32 , 33 , 36 – 38 , 44 , 58 , 59 , 93 , 95 , 96 ]. This is thought to occur due to increased tumor burden resulting in high purine pools and mechanical compression by the lesions [ 6 , 32 , 93 , 95 ]. These may lead to hepatic synthetic dysfunction and impaired uric acid metabolism [ 6 , 32 , 93 , 95 ].…”

“…This is thought to occur due to increased tumor burden resulting in high purine pools and mechanical compression by the lesions [ 6 , 32 , 93 , 95 ]. These may lead to hepatic synthetic dysfunction and impaired uric acid metabolism [ 6 , 32 , 93 , 95 ]. High purine pools and mechanical compression of the non-cancerous tissue could also apply to cases of metastatic disease in the lungs.…”

Fatal Tumour Lysis Syndrome Induced by Brigatinib in a Lung Adenocarcinoma Patient Treated With Sequential ALK Inhibitors: A Case Report

“…Given the seriousness and urgency of the TLS, early prevention and early recognition are vital for reducing mortality. Major risk factors for TLS include but are not limited to a large tumour burden, tumours with a high proliferative rate, highly effective antitumour treatment, liver metastases, and baseline renal insufficiency (Amiri, 2015). According to these risk factors, patients can be divided into low-risk, intermediate-risk, and high-risk groups, which is of central importance to enable stratified management.…”