Waseem Hajjar Adnan Humam, Abbarh Shahem, Al-Mashdali Abdulrahman, Alshurafa Awni, Abu-Tineh Mohammad, Qasim Hana, Ahmed Khalid, Yassin Mohamed A
Internal Medicine Department, Hamad Medical Corporation, Doha, QAT.
Internal Medicine Department, Hamad Medical Corporation, Riyadh, SAU.
Cureus. 2022 Apr 22;14(4):e24386. doi: 10.7759/cureus.24386. eCollection 2022 Apr.
Tumor lysis syndrome (TLS) is a hematological emergency. This syndrome is characterized by metabolic derangements such as hyperkalemia and hypocalcemia, which result from rapid lysis of cells, especially rapidly growing tumors, after the initiation of chemotherapy. It is rarely seen in chronic myeloid leukemia (CML) and has not been previously reported to be triggered by coronavirus disease 2019 (COVID-19) infection. We report a case of a 45-year-old male, a known case of CML in the chronic phase, who presented with fatigue and abdominal pain for four days. Initial laboratory results were consistent with leukocytosis and positive COVID-19 antigen. The patient was started on intravenous fluids and hydroxyurea; however, over the next few days, he deteriorated quickly and developed oliguric acute kidney injury (AKI) with electrolyte disturbance consistent with TLS. The patient was shifted to the intensive care unit and underwent one sustained low-efficiency dialysis (SLED) session and received rasburicase. Over the next few days, the patient started to improve and was discharged in good shape. Although CML rarely presents with TLS, physicians should monitor their patients closely, especially those who have concurrent COVID-19 infection, as this condition may result in lethal sequelae such as AKI, severe arrhythmias, and multiorgan failure. Additionally, early detection and treatment lead to a better prognosis.
肿瘤溶解综合征（TLS）是一种血液学急症。该综合征的特征是代谢紊乱，如高钾血症和低钙血症，这些是化疗开始后细胞快速溶解的结果，尤其是快速生长的肿瘤细胞。它在慢性粒细胞白血病（CML）中罕见，此前也未报告由2019冠状病毒病（COVID-19）感染引发。我们报告一例45岁男性病例，他是慢性期CML已知病例，出现疲劳和腹痛四天。初始实验室检查结果与白细胞增多症和COVID-19抗原阳性相符。患者开始接受静脉输液和羟基脲治疗；然而，在接下来的几天里，他病情迅速恶化，发展为少尿性急性肾损伤（AKI），伴有与TLS一致的电解质紊乱。患者被转至重症监护病房，接受了一次持续性低效透析（SLED）治疗，并接受了重组尿酸酶治疗。在接下来的几天里，患者开始好转，并康复出院。尽管CML很少出现TLS，但医生应密切监测患者，尤其是那些同时感染COVID-19的患者，因为这种情况可能导致致命的后遗症，如AKI、严重心律失常和多器官功能衰竭。此外，早期发现和治疗可带来更好的预后。
