Tumour lysis syndrome in the setting of a high-grade B-cell lymphoma with primary bone marrow localization - a case report.

Tumour lysis syndrome (TLS) is an oncologic emergency usually arising after chemotherapy administration, caused by a massive tumour breakdown and characterized by a specific laboratory and clinical findings. We present a case of TLS, both spontaneous and treatment related, in a 59-year-old woman with high grade B-cell lymphoma without apparent bulky disease on radiologic scans. The patient presented with acute kidney failure with marked hyperuricemia (2764 µmol/L) and extremely high lactate dehydrogenase (LD) activity (13,770 U/L). She was treated with rasburicase, corticosteroid pre-phase therapy, sequential chemotherapy and renal replacement therapy tailored to electrolytic disturbances. After initial resolution of spontaneous TLS, at the start of chemotherapy administration, she experienced systemic inflammatory response (SIRS) and therapy related TLS which included, amongst else, vast hyperphosphatemia (6.12 mmol/L). Despite all intensive care treatment, patient went into multiorgan failure preceding lethal outcome. This case report confirms the value of laboratory parameters in establishing the diagnosis of TLS with LD as an indicator of massive tumour turnover. Due to a high risk of deleterious complications, management of extreme TLS cases challenges the current guidelines of TLS therapy. Modern treatment options such as targeted anticytokine therapy could potentially bring benefit in these specific circumstances.