Faheem Beenish, Kollimuttathuillam Sudarsan, Ashkar Hamdallah, Maroules Michael
Internal Medicine, St. Joseph's University Medical Center, Paterson, USA.
Hematology/Oncology, St. Joseph's University Medical Center, Paterson, USA.
Cureus. 2020 Oct 17;12(10):e11002. doi: 10.7759/cureus.11002.
Tumor lysis syndrome (TLS) is a constellation of metabolic derangements that occur as a consequence of rapid cell turnover in malignancy and the release of intracellular solutes - potassium, phosphate, and nucleic acid metabolites. TLS classically occurs following chemotherapy, with severe renal failure. However, the entity referred to as spontaneous TLS occurs without a precipitating factor of chemotherapy, radiotherapy, steroid therapy, or immunotherapy and can develop in both hematologic and solid malignancies. Here, we report a rare case of a patient who presented with nonspecific symptoms, hyperphosphatemia, hyperuricemia, but hypercalcemia, resultant acute renal failure, with a large mediastinal mass and a pericardial effusion, who was later found to have spontaneous TLS. The workup led to the diagnosis of T-cell leukemia. Spontaneous TLS is often the first manifestation of occult or undetected malignancy, making this oncologic emergency a challenge to manage. The early diagnosis and prompt treatment of spontaneous TLS can reduce morbidity and mortality for patients with an otherwise curable disease.
肿瘤溶解综合征（TLS）是一组代谢紊乱症候群，它是由于恶性肿瘤细胞快速更新以及细胞内溶质（钾、磷酸盐和核酸代谢产物）释放所导致的。TLS典型地发生在化疗之后，并伴有严重肾衰竭。然而，所谓的自发性TLS在没有化疗、放疗、类固醇治疗或免疫治疗等诱发因素的情况下也会发生，并且可在血液系统恶性肿瘤和实体恶性肿瘤中出现。在此，我们报告一例罕见病例，该患者表现为非特异性症状、高磷血症、高尿酸血症，但伴有高钙血症，进而导致急性肾衰竭，同时伴有巨大纵隔肿块和心包积液，后来被发现患有自发性TLS。检查结果最终诊断为T细胞白血病。自发性TLS常常是隐匿性或未被发现的恶性肿瘤的首发表现，这使得这种肿瘤急症的处理成为一项挑战。对自发性TLS的早期诊断和及时治疗可以降低患有可治愈疾病患者的发病率和死亡率。
