Tumour lysis syndrome: an unusual presentation

Abstract

Summary We report a case of spontaneous tumour lysis syndrome that developed postoperatively in a patient with undiagnosed Burkitt’s lymphoma. The former diagnosis was made, unusually, following the development of white emulsion‐like urine in the catheter bag whilst the patient was being managed in the intensive care unit. After laboratory analysis, the urine was found to contain large quantities of uric acid crystals which were the key to the prompt diagnosis. Spontaneous tumour lysis syndrome is rare and this case highlights the difficulties in making an early diagnosis when the presence of a predisposing tumour has not yet been identified. Untreated tumour lysis syndrome can be fatal due to severe biochemical disturbances causing cardiac dysfunction and multi‐organ failure. Early recognition and treatment are crucial to prevent morbidity and mortality. The unusual presentation of this case in association with an undiagnosed Burkitt’s lymphoma emphasises how vigilant anaesthetists and intensivists must be in recognising this potentially life‐threatening condition. We believe that the triggering factor in this case was laparotomy and handling of the tumour.

Uric acid stones in the urinary bladder of aryl hydrocarbon receptor (AhR) knockout mice

“…There have been cases of tumor lysis, which led to large amounts of uric acid in the bladder, causing stone formation (23). In the AhR −/− mice, the urate seemed to accumulate as granules on the luminal side of the urothelial cells, many of which appeared to be undergoing necrosis or apoptosis.…”

Unusual presentation of acute kidney injury with Tumour Lysis Syndrome

“…TLS can be fatal if not recognised early as this can lead to cardiac dysfunction and multi-organ failure due to the severe biochemical disturbances. In-addition to chemotherapy, other triggering factors include corticosteroid therapy, radiotherapy, anaesthesia, and pyrexia (3). Although it can occur spontaneously, TLS is often associated with rapid cell breakdown after initiation of chemotherapy and the consequent massive release of intracellular contents that overwhelm the body's homeostatic and excretory mechanisms (4).…”

Spontaneous Tumor Lysis Syndrome in an Infant: A Case Report

“…The presence of two or more abnormal laboratory tests such as hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcaemia confirms presence of TLS [4]. Hande and Garrow proposed 25 % increase or decrease from the baseline concentrations defines the hyper-or hypo states for laboratory diagnosis of TLS [5]. Clinically TLS was defined as laboratory-defined TLS accompanied by any of the following such as Creatinine level [ 2.5 mg/dL, Potassium level [ 6 mEq/L, Calcium \ 6 mg/dL or development of a life-threatening arrhythmia [1].…”

“…LDH levels [ 1,000 IU/L often hints to the occurrence of TLS. An elevated LDH points to a high tumor burden, thereby making it as one of the probable predictors of TLS [5].…”