CASE OF SPONTANEOUS TUMOR LYSIS SYNDROME IN A PATIENT WITH ACUTE KIDNEY FAILURE AND RECENTLY DIAGNOSED PANCREATIC CANCER

Abstract

SESSION TITLE: Critical Care 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Tumor lysis syndrome (TLS) is a fatal and life-threatening medical emergency. It is the result of massive cytolysis of malignant cells and sudden release of cellular contents into the bloodstream. It usually occurs after chemotherapy in the patient with hematologic malignancies. Tumor lysis syndrome is rare in cases of solid tumors, especially when it occurs spontaneously. It is fatal and life-threatening when associated with solid tumors. Spontaneous tumor lysis syndrome with pancreatic cancer is extremely rare and only few case reports have been published so far. CASE PRESENTATION: 71 years old female recently diagnosed with stage IV pancreatic cancer with extensive metastasis disease, never started on chemotherapy or radiation, presented in the hospital with generalized weakness, shortness of breath and altered mental status. Vitals signs were stable. On physical examination, she was drowsy and sleepy, and moderate tenderness on the right paraspinal area. Initial labs showed elevated creatinine to 4.3, BUN 102, and elevated potassium from the baseline. Her condition worsened over time and rapid response was called. She was found to have increased uric acid, severely elevated creatinine, high phosphorus, and elevated potassium from the baseline. Laboratory findings and clinical features of acute clinical deterioration were suggestive of tumor lysis syndrome. The family opted for palliative with comfort care as per patient wishes. The patient condition worsened rapidly over time and died within 4 hours of diagnosis. She was found to have ventricular fibrillation on telemetry. DISCUSSION: Tumor lysis syndrome is extremely rare in pancreatic cancer, only a few cases of TLS has been reported so far. Aggressive fluid resuscitation to maintain a large urine output remains the mainstay of management. Hypouricemic agents include allopurinol, rasburicase, and febuxostat should be used when suspected the diagnosis of TLS. Mortality is significantly high when associated with solid malignancies even with aggressive management. CONCLUSIONS: Diagnosis of spontaneous tumor lysis syndrome can easily be neglected as it is extremely rare. Spontaneous TLS should be acknowledged in the differential diagnosis for patients who have acute deterioration in clinical conditions, have distinct electrolyte abnormalities with acute renal failure in the setting of malignancy even without cytotoxic treatment, as observed in our case. Prophylactic treatment could be a reasonable option for patients with multiple risk factors for spontaneous TLS. Reference #1: Gemici C: Tumour lysis syndrome in solid tumours. Clin Oncol (R Coll Radiol) 2006;18:773–780. Reference #2: Cairo MS, Coiffier B, Reiter A, Younes A; TLS Expert Panel: Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol 2010;149:578–586. Reference #3: Coiffier B, Altman A, Pui CH, Younes A, Cairo MS: Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008;26:2767–2778. DISCLOSURES: No relevant relationships by Abdul Aleem, source=Web Response no disclosure on file for Harnesh Naik; no disclosure on file for Sangeeta Nanthabalan