Department of Anaesthetics and Intensive Care Medicine, University Hospital of Wales, Heath Park, Cardiff, UK.
Anaesthesia. 2010 Oct;65(10):1031-3. doi: 10.1111/j.1365-2044.2010.06414.x.
We report a case of spontaneous tumour lysis syndrome that developed postoperatively in a patient with undiagnosed Burkitt's lymphoma. The former diagnosis was made, unusually, following the development of white emulsion-like urine in the catheter bag whilst the patient was being managed in the intensive care unit. After laboratory analysis, the urine was found to contain large quantities of uric acid crystals which were the key to the prompt diagnosis. Spontaneous tumour lysis syndrome is rare and this case highlights the difficulties in making an early diagnosis when the presence of a predisposing tumour has not yet been identified. Untreated tumour lysis syndrome can be fatal due to severe biochemical disturbances causing cardiac dysfunction and multi-organ failure. Early recognition and treatment are crucial to prevent morbidity and mortality. The unusual presentation of this case in association with an undiagnosed Burkitt's lymphoma emphasises how vigilant anaesthetists and intensivists must be in recognising this potentially life-threatening condition. We believe that the triggering factor in this case was laparotomy and handling of the tumour.
我们报告了一例术后发生的未诊断的伯基特淋巴瘤自发性肿瘤溶解综合征病例。该病例的先前诊断是非同寻常的，是在患者在重症监护病房中时，在导管袋中出现乳白色尿液后做出的。经过实验室分析，发现尿液中含有大量尿酸晶体，这是快速诊断的关键。自发性肿瘤溶解综合征很罕见，本例强调了当尚未确定潜在肿瘤存在时，早期诊断的困难。未经治疗的肿瘤溶解综合征可能因严重的生化紊乱导致心脏功能障碍和多器官衰竭而致命。早期识别和治疗对于预防发病率和死亡率至关重要。本例与未诊断的伯基特淋巴瘤相关的不寻常表现强调了麻醉师和重症监护医生必须警惕识别这种潜在的危及生命的情况。我们认为，该病例的触发因素是剖腹手术和肿瘤处理。
