2702 Tumor Lysis Syndrome in a Patient With Gastric Adenocarcinoma

Abstract

INTRODUCTION: Tumor lysis syndrome (TLS), considered a hematologic emergency, is uncommonly seen with solid tumors. TLS is most often seen in the context of aggressive lymphomas, where cell turnover is high. We present a case of tumor lysis syndrome in a patient with gastric adenocarcinoma, as a complication of FOLFOX (5-fluorouracil, leucovorin, oxaliplatin) chemotherapy. CASE DESCRIPTION/METHODS: 48-year-old male with metastatic gastric adenocarcinoma (Figure 1), who received his first cycle of FOLFOX 4 days prior, presented to the emergency department with slurred speech and altered mental status. Vitals at presentation were normal. Systemic examination was remarkable for agitation and disorientation to time, place and person. He had no focal neurologic deficits and rest of the exam was unremarkable. CT scan of the head and EEG were unrevealing. Laboratory analysis was significant for an elevated creatinine, phosphorus and uric acid (Table 1 day 5). The pattern of electrolyte abnormalities and their development after recent chemotherapy was consistent with a diagnosis of chemotherapy-induced laboratory and clinical TLS. Patient was managed with aggressive IV fluids and rasburicase, following which, the electrolyte abnormalities resolved, and he improved clinically back to baseline. DISCUSSION: Tumor lysis syndrome occurs when tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy, leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Complications include renal insufficiency, cardiac arrhythmias, seizures and death. Rapidly proliferating tumors like high-grade lymphomas and acute leukemias are predisposed to TLS. TLS occurs infrequently with solid tumors. TLS-associated mortality rate, with solid tumors, is around 35%; higher than that with hematologic malignancies. This is likely explained because prophylactic measures are implemented more often in hematological malignancies and less often in solid tumors. Our patient fulfilled the Cairo-Bishop criteria for grade II TLS. To our knowledge, there have been only nine cases of TLS secondary to gastric adenocarcinoma published in the literature. We present the first case of FOLFOX-induced TLS in a patient with gastric adenocarcinoma. This case highlights the importance of early recognition of TLS in patients with gastric cancer. Initiation of early treatment can reduce the high morbidity and mortality associated with this condition.