Spontaneous Tumor Lysis Syndrome: A Rare Presentation in Plasmablastic Lymphoma

Abstract

Tumor lysis syndrome is an oncological emergency, which can ultimately lead to death if not recognized early and treated accordingly. The institution of adequate prophylactic measures can decrease its incidence and severity; but very rarely, a highly aggressive neoplasm such as acute lymphoblastic leukemia or Burkitt's lymphoma can present with spontaneous tumor lysis syndrome (sTLS). We present the case of a 58-year-old male with newly diagnosed plasmablastic lymphoma with a retroperitoneal bulky mass invading the bladder, who presented with severe sTLS and was admitted to an intensive care unit due to acute renal failure and hyperkalemia requiring emergent renal replacement therapy. With urgent chemotherapy, several hemodialysis sessions and rasburicase, all the metabolic derangements were corrected and the patient fully recovered a normal renal function. This report highlights the importance of early recognition of sTLS in any patient presenting with severe and de novo multiple metabolic derangements involving uric acid, phosphorus, calcium and creatinine, even in patients with tumors not usually presenting with this complication.

Keywords: Dialysis; Plasmablastic lymphoma; Spontaneous tumor lysis syndrome.

Figure 1

Abdominopelvic CT scan displaying a solid polylobulated retroperitoneal mass which invades the bladder wall, measuring approximately 10 × 10 centimeters. CT: computed tomography.

Figure 2

Evolution of serum phosphate concentration over time, since intensive care admission (day 1). The hyperphosphatemia, although significant, was not as proportionately elevated as the remaining tumor lysis parameters. This, however, changed once chemotherapy was initiated, with a spike from 8 mg/dL to approximately 13 mg/dL, and hence requiring two hemodialysis sessions to correct this serious hyperphosphatemia.

Figure 3

Pathophysiology of tumor lysis syndrome and its clinical implications.