Sultan Feehaan H, Jindal Priya K, Sultan Zeeshaan H, Bansal Nahush R, Qiu Shuhao
Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Case Rep Oncol. 2025 Feb 21;18(1):413-419. doi: 10.1159/000544865. eCollection 2025 Jan-Dec.
Spontaneous tumor lysis syndrome (TLS) is a rare, life-threatening metabolic complication that typically occurs in malignancies with high tumor burden. Early recognition is critical, even in the absence of a known malignancy, to prevent severe outcomes.
We report the case of an 89-year-old male with a history of chronic kidney disease, hyperparathyroidism, and myasthenia gravis, who experienced three episodes of TLS within 1 month. Initially, his metabolic disturbances were misattributed to dehydration. During his second admission, imaging revealed extensive lymphadenopathy, and a lymph node biopsy confirmed follicular helper T-cell lymphoma before his third hospitalization. Despite aggressive treatment, he developed metabolic encephalopathy and lost his decision-making capacity, while his family declined palliative care discussions.
This case highlights the importance of considering TLS in patients with unexplained hyperkalemia, hyperuricemia, and hyperphosphatemia, even in the absence of a malignancy diagnosis. Early diagnosis and multidisciplinary care are essential to improve outcomes.
自发性肿瘤溶解综合征（TLS）是一种罕见的、危及生命的代谢并发症，通常发生于肿瘤负荷高的恶性肿瘤患者。即使在未确诊恶性肿瘤的情况下，早期识别对于预防严重后果也至关重要。
我们报告一例89岁男性患者，有慢性肾脏病、甲状旁腺功能亢进症和重症肌无力病史，在1个月内发生了3次TLS。最初，他的代谢紊乱被误诊为脱水。第二次住院期间，影像学检查发现广泛的淋巴结病，淋巴结活检在第三次住院前确诊为滤泡辅助性T细胞淋巴瘤。尽管进行了积极治疗，但他仍发展为代谢性脑病并丧失了决策能力，而其家属拒绝进行姑息治疗讨论。
该病例强调了即使在未确诊恶性肿瘤的情况下，对于不明原因的高钾血症、高尿酸血症和高磷血症患者考虑TLS的重要性。早期诊断和多学科治疗对于改善预后至关重要。
