Case report of a laparoscopic biopsy found to trigger spontaneous tumor lysis syndrome in pediatric Burkitt lymphoma.

Background: The article presents a rare case of a five-year-old girl with Burkitt lymphoma (BL) who developed tumor lysis syndrome (TLS) after undergoing diagnostic laparoscopic surgery. Although TLS is typically associated with the initiation of chemotherapy, spontaneous TLS (STLS) can rarely occur after surgery. It remains clinically challenging to assess the risk of TLS in pediatric patients with suspected malignancy at initial presentation without a histological diagnosis. In essence, BL complicated by STLS constitutes a distinct clinical entity that requires urgent identification and management in order to improve the prognosis. Case Description: The patient was admitted to the surgical department presenting with a 2-week history of fatigue, abdominal discomfort, and distension. A computed tomography (CT) scan revealed a large retroperitoneal mass with multiple metastases. The child subsequently underwent a laparoscopic biopsy. After surgery, she developed a high fever that progressed to cardiac arrest and hemodynamic collapse. We rapidly diagnosed STLS based on the presence of characteristic biochemical abnormalities. She was successfully resuscitated with continuous renal replacement therapy (CRRT) and other supportive measures. The pathology results confirmed BL. The patient has completed chemotherapy with no evidence of relapse to date; however, residual lower-extremity motor deficits persist. Conclusions: Clinicians must recognize surgical biopsy and fever as potential triggers for STLS in pediatric patients with bulky malignancies. This underscores the necessity of preoperative risk stratification and prophylactic management in high-risk groups. For established TLS, timely intervention with modalities like CRRT is critical to mitigate life-threatening complications.