Tumor Lysis Syndrome in a Patient with Merkel Cell Carcinoma and Provoked Pathologic Sequence of Acute Kidney Injury, Reduced Clearance of Carboplatin and Fatal Pancytopenia

Abstract

Background: Merkel cell carcinoma (MCC) is a rare, highly malignant cancer of the skin primarily affecting the elderly, with a tendency for local recurrence and regional lymph node metastasis. It is very unusual for this kind of tumor to induce clinically apparent tumor lysis syndrome (TLS) which is a consequence of spontaneous cytolysis or massive tumor cell lysis, beginning a few hours after the initiation of treatment. Case Report: We report here on a patient with metastatic MCC, who developed TLS following combination chemotherapy with carboplatin and etoposide. Conclusion: The evolving acute kidney injury (AKI) provoked a pathologic sequence of reduced renal clearance leading to protracted clearance of carboplatin and subsequent fatal pancytopenia. When AKI occurs in close association with the administration of carboplatin, the institution of rescue hemodialysis is recommended to decrease plasma carboplatin levels and avoid this lethal complication.

Tumor Lysis Syndrome in Solid Tumors: An up to Date Review of the Literature

“…102-110 Two cases consisted of metastatic Merkel cell carcinoma, 102,110 while others were metastatic melanoma. One patient with Merkel cell carcinoma was a 65 year old female with baseline elevation of LDH, mild elevation of creatinine (there was evidence of hydronephrosis) and uric acid.…”

“…102 The second patient with Merkel cell carcinoma was an 86 year old female who had baseline elevation of LDH and developed TLS on the third day after initiation of chemotherapy. 110 …”