Desai Milap, Parsi Meghana, Potdar Rashmika, Sanjay Rashmi
Hematology/Oncology, Drexel University College of Medicine, Philadelphia, USA.
Internal Medicine, Crozer-Keystone Health System, Upland, USA.
Cureus. 2020 Oct 31;12(10):e11279. doi: 10.7759/cureus.11279.
Tumor lysis syndrome (TLS) is the phenomenon of metabolic derangements that typically follows the initiation of cytotoxic chemotherapy. Metabolic disturbances include hyperphosphatemia, hyperkalemia, hyperuricemia and hypocalcemia. Hematological malignancies are associated with spontaneous TLS (STLS), which is cell lysis in the absence of chemotherapy. STLS is extremely rare in chronic lymphocytic leukemia (CLL). This has been documented only once in the medical literature, making this an extraordinarily uncommon case. We present here a 68-year-old male with a history of benign prostatic hyperplasia (BPH) who is admitted for a two-week history of abdominal pain and three days of anuria, despite adequate fluid intake. Laboratory values yielded a greatly elevated leukocyte count with a lymphocytic predominance and smudge cells. Potassium, phosphorus, and uric acid were also significantly increased. EKG revealed peaked T-waves. Flow cytometry confirmed the presence of an abnormal B-cell population consistent with B-cell chronic lymphocytic leukemia, with the following markers: CD19+, CD20+, CD23+, CD5+, CD10-. He was diagnosed with CLL and treated with aggressive fluid resuscitation, allopurinol and rasburicase. The patient had another similar episode within one month. His CLL fluorescence in-situ hybridization (FISH) showed complex cytogenetics with unmutated IgVH and he was subsequently started on ibrutinib.
肿瘤溶解综合征（TLS）是一种代谢紊乱现象，通常发生在细胞毒性化疗开始之后。代谢紊乱包括高磷血症、高钾血症、高尿酸血症和低钙血症。血液系统恶性肿瘤与自发性肿瘤溶解综合征（STLS）相关，后者是指在未进行化疗情况下的细胞溶解。STLS在慢性淋巴细胞白血病（CLL）中极为罕见。医学文献中仅记载过一次，因此这是一个极其罕见的病例。我们在此报告一名68岁男性，有良性前列腺增生（BPH）病史，因腹痛两周、无尿三天入院，尽管液体摄入量充足。实验室检查结果显示白细胞计数大幅升高，以淋巴细胞为主，并出现涂抹细胞。钾、磷和尿酸也显著升高。心电图显示T波高尖。流式细胞术证实存在异常B细胞群，符合B细胞慢性淋巴细胞白血病，具有以下标志物：CD19+、CD20+、CD23+、CD5+、CD10-。他被诊断为CLL，并接受了积极的液体复苏、别嘌醇和拉布立酶治疗。该患者在一个月内又出现了一次类似发作。他的CLL荧光原位杂交（FISH）显示复杂的细胞遗传学特征，IgVH未突变，随后开始使用伊布替尼治疗。
