Spontaneous Tumor Lysis Syndrome: Case Report from UMAE No.71 and Review of the Literature

Abstract

Tumor lysis (TLS) is an oncologic emergency resulting from the massive release of intracellular  metabolites after rapid tumor cell destruction. Although it usually occurs after cytotoxic chemotherapy, spontaneous TLS may develop before treatment, especially in high-grade hematologic malignancies such as Burkitt lymphoma. We report the case of a 42-year-old male patient with constitutional symptoms, progressive abdominal distension, dyspnea, bulky abdominal and retroperitoneal disease, and histopathological findings compatible with non-Hodgkin  lymphoma. On initial hematologic evaluation, laboratory test showed acute kidney injury, severe hyperuricemia, hyperkalemia and hyperphosphatemia, consistent with TLS before chemotherapy. HIV infection was subsequently confirmed and bone marrow aspiration was compatible with Burkitt lymphoma/leukemia. Despite intravenous hydration, allopurinol, phosphate binders, and urgent hemodialysis, the patient developed refractory metabolic abnormalities. Following induction chemotherapy with HyperCVAD, TLS worsened, leading to severe hyperkalemia with  a sinusoidal electrocardiographic pattern and death. Spontaneous TLS is a rare but life-threatening complication requiring early recognition, risk stratification, and prompt multidisciplinary management..