Froilán Torres C, Castro Carbajo P, Pajares Villarroya R, Plaza Santos R, Gómez Senent S, Martín Arranz M D, Adán Merino L, Martín Arranz E, Manceñido Marcos N, Peces R, Benito López D
Service of Digestive diseases, University Hospital La Paz and Hospital Infanta Sofía, Madrid, Spain.
Rev Esp Enferm Dig. 2009 Apr;101(4):288-94.
Acute tumour lysis syndrome (TLS) is a catastrophic complication of the treatment of certain neoplastic disorders. It most commonly occurs in association with hematologic malignancies and appears a few hours to a few days after initiation of specific chemotherapy, as the result from the release of intracellular components into the bloodstream due to abrupt malignant cell death. Acute spontaneous TLS is rare, and it has been described in leukemia and lymphoma and in some patients with solid tumors prior to institution of therapy. The syndrome is characterized by hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia, and acute oliguric or anuric renal failure due to uric acid precipitation within the tubules (acute uric acid nephropathy) and to calcium phosphate deposition in the renal parenchyma and vessels.We report a case of acute spontaneous TLS in a patient with Crohn s disease treated with immunosuppressive drugs, who developed a plasmocytoma, in which serum uric acid concentration attained exceptionally high levels (44 mg/dL). The patient underwent acute oliguric renal failure, which required treatment with hyperhydration, urine alkalinization, urate oxidase and hemodialysis, with a fatal evolution.In conclusion, the present case report has several peculiarities: that of being one of the rare examples of spontaneous TLS, that of showing an exceptionally severe hyperuricemia, probably the highest ever reported in the literature, and that of the possible increased risk of tumours in patients with Crohn s disease taking inmunosuppressives and/or TNF antagonists.
急性肿瘤溶解综合征（TLS）是某些肿瘤性疾病治疗过程中的一种灾难性并发症。它最常与血液系统恶性肿瘤相关，在启动特定化疗后的数小时至数天内出现，这是由于恶性细胞突然死亡导致细胞内成分释放到血液中所致。急性自发性TLS较为罕见，已在白血病、淋巴瘤以及一些实体瘤患者在治疗前被描述过。该综合征的特征为高尿酸血症、高磷血症、低钙血症、高钾血症，以及由于尿酸在肾小管内沉淀（急性尿酸肾病）和磷酸钙在肾实质及血管中沉积导致的急性少尿或无尿性肾衰竭。我们报告一例克罗恩病患者在接受免疫抑制药物治疗后发生浆细胞瘤并出现急性自发性TLS的病例，该患者血清尿酸浓度达到极高水平（44mg/dL）。患者出现急性少尿性肾衰竭，需要进行补液、尿液碱化、尿酸氧化酶及血液透析治疗，但最终死亡。总之，本病例报告有几个特殊之处：它是自发性TLS的罕见病例之一；表现出异常严重的高尿酸血症，可能是文献中报道过的最高水平；以及克罗恩病患者服用免疫抑制剂和/或肿瘤坏死因子拮抗剂可能增加肿瘤发生风险。
