Spontaneous tumor lysis syndrome and hemophagocytic lymphohistiocytosis in metastatic melanoma: A case series and review of the literature

Abstract

Introduction: Tumor lysis syndrome (TLS) and hemophagocytic lymphohistiocytosis (HLH) are two medical emergencies associated with malignancy and treatment thereof. More commonly they are associated with treatment of fast growing and highly chemotherapy-responsive tumors such as lymphomas and small cell lung cancer. However, a growing body of evidence demonstrates they can occur with other malignancies, such as melanoma, and can happen spontaneously prior to treatment initiation. Case Series: We describe two cases of patients with metastatic melanoma who experienced rapid progressive clinical decline prior to initiation of treatment for their metastatic disease. Laboratory findings at the time of presentation in both cases were consistent with TLS. The second case was further complicated by possible HLH, though diagnosis and treatment remained controversial among our team. Conclusion: We hope these reports increase awareness of the risk of spontaneous TLS and HLH in metastatic melanoma, foster discussion of the difficulty of defining HLH, and shed light on their prognostic implications and management.