Low-dose steroid-induced tumor lysis syndrome in a hepatocellular carcinoma patient

Kim, Jin O.k.; Jun, Dae Won; Tae, Hye Jin; Lee, Kang N.yeong; Lee, Hang L.ak; Lee, Oh Y.oung; Choi, Ho Soon; Yoon, Byung Chul; Hahm, Joon Soo

doi:10.3350/cmh.2015.21.1.85

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…Despite its low incidence, TLS from solid tumors is associated with a much higher mortality rate (around 35%) compared to that of TLS among hematologic malignancies (around 1.9%) [ 7 ]. Although HCC represents a mere 8% of all solid tumors with documented TLS [ 13 ], the mortality rate of TLS from HCC can be as high as 50% owing to poor recognition and delayed diagnosis [ 5 ]. Similar to hematologic malignancies, solid tumors can develop TLS spontaneously or after cancer-targeted interventions such as radiation, chemotherapy, radiofrequency, or chemoembolization [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Tumor Lysis Syndrome Following Thoracotomy Under Cardiopulmonary Bypass in a Case of Hepatocellular Carcinoma With Right Atrial and Inferior Vena Cava Tumor Thrombus

Shih¹

2021

Cureus

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Tumor lysis syndrome (TLS) occurring after surgical resection of right atrium (RA) and inferior vena cava (IVC) tumor thrombus is a very rare but insidious condition. We report a case of hepatocellular carcinoma who developed TLS after uneventful excision of RA+IVC tumor thrombus under median sternotomy and cardiopulmonary bypass (CPB). Although the procedure was not expected to arouse massive tumor cell necrosis, post-operative course was complicated by metabolic acidosis, hypocalcemia, and progressive hyperkalemia indicative of TLS. Unfortunately, laboratory diagnosis of TLS was delayed under conditions of continuous renal replacement therapy (CRRT) for peri-operative acute renal failure. Despite all efforts, the patient died 36 hours after surgery due to lethal arrhythmia and disseminated infarction of the kidneys, spleen, and liver.

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Section: Discussionmentioning

confidence: 99%

Tumor Lysis Syndrome Following Thoracotomy Under Cardiopulmonary Bypass in a Case of Hepatocellular Carcinoma With Right Atrial and Inferior Vena Cava Tumor Thrombus

Shih¹

2021

Cureus

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“…These exhaust the body's homeostatic mechanisms resulting in the characteristic findings of hyperuricaemia, hyperkalaemia, hyperphosphataemia and hypocalcaemia [ 6 ]. These intracellular substances alongside released cytokines have potentially toxic effects leading to AKI, cardiac arrhythmias, seizures, multi-organ failure and eventually death [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Steroid-induced tumour lysis syndrome in small-cell lung cancer

Khan

Ayub

Mehmood

et al. 2017

Oxford Medical Case Reports

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A 64-year-old male presented to hospital with breathlessness and weight loss. Ultrasound-guided biopsy of supraclavicular lymph node confirmed a diagnosis of small-cell lung cancer. The patient was started on Dexamethasone 8 mg twice daily for symptom control while awaiting urgent oncology assessment. Three days later he was admitted with acute kidney injury and worsening breathlessness. Biochemical changes confirmed tumour lysis syndrome (TLS) that had occurred following steroid therapy. He was given allopurinol followed by rasburicase. His clinical condition continued to worsen and he died of multi-organ failure. To our knowledge, TLS in small-cell lung cancer solely attributed to steroid therapy has not been described before. Due to its rarity, physicians have a very low index of suspicion of TLS in lung cancer when prescribing corticosteroids for palliation of symptoms. Patients with risk factors should be identified and baseline blood tests performed and appropriate prophylaxis commenced.

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“…In the present case, the WBC count peaked at 20,000 cells/μL (eosinophil 10,900 cells/μL) before steroid therapy was started, and doubled within a few days, indicating a high proliferating rate. Effective steroid pulse therapy also could have played a role in the onset of tumor lysis-like syndrome ( 16 , 18 - 28 ). Steroids induce eosinophil apoptosis through the direct promotion of apoptotic cascades, suppression of the synthesis and effects of eosinophil survival factors, and the stimulation of their engulfment by phagocytes ( 29 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

Tumor Lysis-like Syndrome in Eosinophilic Disease of the Lung: A Case Report and Review of the Literature

et al. 2016

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Tumor lysis syndrome (TLS) is a metabolic disorder that is generally associated with a malignancy leading to hyperuricemia, hyperphosphatemia, and acute kidney injury. On the other hand, we sometimes encounter these phenomena in nonmalignant disease, which has been referred to as tumor lysis-like syndrome in some studies. We herein experienced a case in which tumor lysis-like syndrome occurred in the course of therapy for eosinophilic disease of the lung, a nonmalignant disease. Even in nonmalignant disease, massive cell lysis induced by therapy can cause phenomena such as TLS or tumor lysis-like syndrome.

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Low-dose steroid-induced tumor lysis syndrome in a hepatocellular carcinoma patient

Cited by 14 publications

References 19 publications

Tumor Lysis Syndrome Following Thoracotomy Under Cardiopulmonary Bypass in a Case of Hepatocellular Carcinoma With Right Atrial and Inferior Vena Cava Tumor Thrombus

Tumor Lysis Syndrome Following Thoracotomy Under Cardiopulmonary Bypass in a Case of Hepatocellular Carcinoma With Right Atrial and Inferior Vena Cava Tumor Thrombus

Steroid-induced tumour lysis syndrome in small-cell lung cancer

Tumor Lysis-like Syndrome in Eosinophilic Disease of the Lung: A Case Report and Review of the Literature

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