Abstract
Tumor lysis syndrome (TLS) is a fatal complication of chemotherapy treatment. It is rarely seen in the treatment of solid tumors particularly in breast cancer. We presented the case of a chemo-naïve 58-year-old Caucasian woman who developed tumor lysis syndrome (TLS) after a single treatment dose of gemcitabine for metastatic breast cancer. Despite optimal management, the patient clinically deteriorates and is referred to inpatient hospice. Although targeted chemotherapy options have become increasingly effective, physicians should be aware of the rare, yet often fatal complications of TLS. Similarly, physicians should be able to quickly recognize the development of TLS to ensure swift and effective prophylaxis or treatment.
Highlights
Tumor lysis syndrome (TLS) is defined as an oncologic emergency, characterized by massive tumor cell lysis and the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. It is often seen as a result of chemotherapy treatment of lymphomas and T-cell acute lymphoblastic leukemias [1]
We have described a rare case of TLS that occurred after a single treatment of gemcitabine, which only rarely causes TLS in solid tumors, in the context of metastatic breast cancer in a chemo-naïve patient [1]
TLS is more likely to happen in more indolent proliferations such as that seen in leukemias or lymphomas [3]
Summary
Tumor lysis syndrome (TLS) is defined as an oncologic emergency, characterized by massive tumor cell lysis and the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. A Port-A-Cath had been placed successfully without any complications two days before the first chemotherapy treatment On this present admission, her blood tests showed high uric acid levels (18.2 mg/dL), hyperphosphatemia (6.7 mg/dL), hyperkalemia (5.4 mmol/L), calcium (9.6 mg/dL), increased creatinine (3.38 mg/dL) and decreased glomerular filtration rate (14 mL/min). By day two of admission, the patient appeared jaundiced and lethargic but was still alert and oriented Her blood tests showed high uric acid levels (15.1 mg/dL), hyperphosphatemia (6.1 mg/dL), potassium (4.7 mmol/L), calcium (9.0 mg/dL), increased creatinine (2.69 mg/dL), and decreased glomerular filtration rate (18 mL/min). By day six of admission, the patient’s blood tests showed high uric acid levels (11.1 mg/dL), potassium (4.0 mmol/L), calcium (8.7 mg/dL), increased creatinine (2.71 mg/dL), and decreased glomerular filtration rate (18 mL/min). It was decided by the patient, husband, and daughter that the patient would have a ‘do not resuscitate’ order and would be transferred to inpatient hospice when stable
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