Tumor lysis syndrome (TLS) is an oncologic emergency that generally triggered by effective cytotoxic chemotherapy in a context of rapidly proliferating and chemo-sensitive tumor or in patients with massive tumor burden. TLS has been rarely described in patients with solid tumors, and it is even more uncommon to have spontaneous tumor lysis syndrome (STLS). To our knowledge, only three cases of STLS in metastatic breast cancer were reported in the literature. Herein, we present a new case of STLS in a 37-year-old female with giant neglected metastatic breast cancer. She subsequently developed acute oliguric renal failure and multiple electrolyte abnormalities requiring hemodialysis. Despite aggressive supportive care, the patient developed multiple organ failure and died eight days after admission. Our case highlights the importance of increased awareness of this rare but life threatening condition. TLS should be included in the differential diagnosis of patients with newly diagnosed breast cancer who present with acute kidney injury even before they receive any active cancer therapy
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