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Case Reports
. 2025 Jun 15;64(12):1872-1876.
doi: 10.2169/internalmedicine.3892-24. Epub 2024 Nov 21.

Severe Hypophosphatemia Potentially Associated with Intracellular Phosphate Shift Concomitant with Acute Kidney Injury in a Patient with Rapidly Proliferating Diffuse Large B-cell Lymphoma

Suzuka Chayama  1 , Hirotaka Sato  2 , Kentaro Takase  2 , Katsuki Hayashi  3 , Takaaki Miyake  3 , Seikon Kin  2
Affiliations
Case Reports

Severe Hypophosphatemia Potentially Associated with Intracellular Phosphate Shift Concomitant with Acute Kidney Injury in a Patient with Rapidly Proliferating Diffuse Large B-cell Lymphoma

Suzuka Chayama et al. Intern Med. .

Abstract

An 85-year-old woman with diffuse large B-cell lymphoma developed severe hypophosphatemia (serum phosphate 0.3 mg/dL) concomitant with acute kidney injury (serum creatinine 2.05 mg/dL) following chemotherapy. Because urine phosphate was undetectable, hypophosphatemia was likely due to the vigorous uptake of phosphate into the rapidly proliferating tumor cells, also known as tumor genesis syndrome (TGS), and acute kidney injury was potentially attributed to the antibiotics sulfamethoxazole/trimethoprim. Oral phosphate supplementation and antibiotic discontinuation alleviated both the abnormalities. This case was unusual, as tumorigenesis syndrome is seldom seen in patients with lymphoma, and acute kidney injury usually leads to hyperphosphatemia. The present case emphasizes the importance of vigilance in hypophosphatemia due to TGS during chemotherapy.

Keywords: acute kidney injury; diffuse large B-cell lymphoma; hypophosphatemia; tumor genesis syndrome.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Horizontal images of non-contrast abdominal computed tomography. a: A large mass occupying the pelvis (white dotted circle) is observed on admission. b: No hydronephrosis observed on admission. c: A reduction in tumor size was confirmed (white dotted circle) on day 18. d: No hydronephrosis was observed on day 18. e: Tumor enlargement (white dotted circle) observed on day 25. f: Bilateral hydronephrosis (white arrows) developed rapidly in a week on day 25.
Figure 2.
Figure 2.
Clinical course of the patient. The patient’s renal function improved rapidly with mild fluid supplementation without stent placement. Hypophosphatemia also improved following oral phosphate supplementation. IP: inorganic phosphate, Cr: creatinine, R-CHOP: rituximab 375 mg/m2, cyclophosphamide 375 mg/m2, vincristine 0.4 mg/m2, doxorubicin 25 mg/m2, prednisolone 20 mg/body, ST: sulfamethoxazole 400 mg+trimethoprim 80 mg
See this image and copyright information in PMC

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