An Autopsy Case Report of ARDS Caused by Tumor Lysis Syndrome in A Patient with Mantle Cell Lymphoma

Abstract

Abstract Introduction/Objective Acute respiratory distress syndrome (ARDS) is a type of respiratory failure caused by diffuse injury to surfactant-producing cells and fluid buildup in the alveoli. ARDS impairs lung's ability and is potentially fatal. Tumor lysis syndrome is an oncologic emergency mostly triggered by the initiation of chemotherapy causing life- threatening metabolic cascades even with preventable therapies. Methods/Case Report We report an autopsy case of a 71-year-old male who was referred to the Emergency Department with complaints of poor appetite, dizziness, nausea. He was found to have a white blood cell count over 1,000,000, with hemoglobulin of 7.7, platelet count of 95, uric acid 11.5, LDH 486. He was diagnosed with mantle cell lymphoma (MCL) involving peripheral blood and received Allopurinol for tumor lysis syndrome prophylaxis. He started to receive Rituximab. Soon after, he became lethargic and more hypoxemic and needed intubation. But he became pulseless and he did not recover. Results (if a Case Study enter NA) The autopsy revealed an extensive spread of the lymphoma to multi-organs, including the esophagus, spleen, liver, kidney, heart, prostate. Bone marrow and lymph nodes were diffusely infiltrated by atypical medium lymphocytes. Stains on lymph nodes show the atypical lymphocytes are positive for CD20, CD5, Cyclin D1, Bcl2, negative for CD23, Bcl6, with a Ki-67 proliferative index around 40%, consistent with MCL. The patient's lungs were heavy and microscopic examination confirmed ARDS. Conclusion We, here describe a patient with MCL who developed tumor lysis syndrome with Rituximab monotherapy and died of ARDS shortly after. It's rarely reported that tumor lysis syndrome results in fatal ARDS.