SPONTANEOUS TUMOR LYSIS SYNDROME IN METASTATIC SMALL CELL LUNG CANCER

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Tumor lysis syndrome is a rare, potentially life-threatening complication that may occur either spontaneously or as result of anticancer therapies. This occurs from massive, abrupt release cellular contents into the bloodstream tumor cells. It in renal failure, cardiac arrhythmia, seizure, and death. Solid tumor-associated carrying less than 1% risk, spontaneous usually associated with highly proliferative tumors large burdens. CASE PRESENTATION: 68-year-old male presents generalized weakness fatigue was diagnosed resulting newly solid cancer, small cell carcinoma. He presented extreme multiple falls. Past medical history pertinent for rheumatoid arthritis on methotrexate golimumab. On physical exam patient had icteric sclera, mild abdominal distention palpable liver, bilateral 2+ pitting edema, without alcohol use. His labs showed transaminitis, elevated bilirubin, acute kidney injury, proteinuria, hematuria uric crystals calcium oxalate, d-dimer, CRP, troponin elevation. CT chest, abdomen, pelvis relieved hepatomegaly, diffuse lymphadenopathy. Bone marrow liver biopsies were obtained resulted metastatic carcinoma/neuroendocrine case discusses epidemiology, treatment, prognosis syndrome. DISCUSSION: The massive blood stream can have seizure be by hyperuricemia, hyperkalemia, hyperphosphatemia, and/or hypocalcemia. most commonly after initiation treatment malignancies, rarely high-grade hematological tumors. Spontaneous present 1.1% patient's cancer presenting hyperuricemic failure. Abdominal organ involvement nonspecific initial presentation obscure nature disease delaying diagnosis. Poor outcomes patients develop acid nephropathy requiring aggressive management prompt dialysis. Proposed pathophysiology intracellular ions nucleic acids metabolized to which excreted kidneys, crystallize obstructive uropathy. Uric decreases nitric oxide vasoconstriction ischemia has pro-inflammatory affects. CONCLUSIONS: secondary rare cause metabolic derangements high mortality rate early treatment. REFERENCE #1: Hsu HH, Chan YL, Huang CC. Acute failure: clinical features therapeutic approach. J Nephrol. 2004;17(1):50-56. #2: Criscuolo M, Fianchi L, Dragonetti G, Pagano L. syndrome: review pathogenesis, risk factors emergency. Expert Rev Hematol. 2016;9(2):197-208 #3: Coiffier B, Altman A, Pui CH, Younes Cairo MS. Guidelines pediatric adult an evidence-based review. Clin Oncol. 2008 Jun 1;26(16):2767-78, correction found 2010 Feb 1;28(4):708, commentary Oncol Dec 1;26(34):5657 DISCLOSURES: No relevant relationships Katie Alsheimer, source=Web Response