Spontaneous Tumor Lysis Syndrome in T-Cell Leukemia

Abstract

Tumor lysis syndrome (TLS) is a constellation of metabolic derangements that occur as a consequence of rapid cell turnover in malignancy and the release of intracellular solutes-potassium, phosphate, and nucleic acid metabolites. TLS classically occurs following chemotherapy, with severe renal failure. However, the entity referred to as spontaneous TLS occurs without a precipitating factor of chemotherapy, radiotherapy, steroid therapy, or immunotherapy and can develop in both hematologic and solid malignancies. Here, we report a rare case of a patient who presented with nonspecific symptoms, hyperphosphatemia, hyperuricemia, but hypercalcemia, resultant acute renal failure, with a large mediastinal mass and a pericardial effusion, who was later found to have spontaneous TLS. The workup led to the diagnosis of T-cell leukemia. Spontaneous TLS is often the first manifestation of occult or undetected malignancy, making this oncologic emergency a challenge to manage. The early diagnosis and prompt treatment of spontaneous TLS can reduce morbidity and mortality for patients with an otherwise curable disease.

Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System

“…Systemic tumor lysis syndrome b [1,2, Spontaneous (idiopathic) c [1,2,[6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Hematologic malignancies [1,6,10,[12][13][14][15] Solid tumors [2,7,8,10,11,[15][16][17][18][19][20][21][22][23] Therapy-associated d [1,2,[9][10][11]15,17,20,21,[23]…”

“…Spontaneous (idiopathic) systemic tumor lysis syndrome is less common than therapy-associated tumor lysis syndrome. However, multiple reports now document its occurrence [1,2,[6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

“…Hematologic malignancies: Spontaneous (idiopathic) systemic tumor lysis syndrome has been observed in patients with leukemia and lymphoma [12][13][14]. For some of these patients, malignancy may have been recently diagnosed and treatment was being planned [13].…”

“…Eventually, they seek medical attention, and the abnormal serum chemistry results from preliminary laboratory studies prompt consideration of systemic tumor lysis syndrome. The complete blood cell count or computerized axial tomography examination subsequently disclose aberrations that lead to biopsy of the bone marrow or lymph node or both to establish the diagnosis of the associated hematologic malignancy [1,6,10,[12][13][14][15].…”

“…For some of these patients, malignancy may have been recently diagnosed and treatment was being planned [ 13 ]. However, in other individuals, idiopathic systemic tumor lysis syndrome was the presenting manifestation of their previously undiagnosed leukemia or lymphoma [ 12 , 14 ].…”