Tumor lysis syndrome in a patient with metastatic cholangiocarcinoma

Document Type

Conference Proceeding

Publication Date

10-1-2021

Publication Title

Am J Gastroenterol

Abstract

Introduction: Tumor lysis syndrome (TLS) is an oncological emergency of various types of cancers and their treatments. It is commonly reported in patients with hematological malignancies with high cellular turnover including leukemias and lymphomas. We present a case of a 33-year-old man who developed TLS two weeks after initiating chemotherapeutic treatment for metastatic cholangiocarcinoma, a treatment regimen, and a tumor with rare incidence of this complication. Case Description/Methods: A 33-year-old man presented with abdominal pain and progressive weight loss. Physical examination revealed distended abdomen without signs for ascites and hepatomegaly. Laboratory work-up included AFP of 1.7 ng/mL, CA 19-9 of 177 unit/mL, CEA of 8.1 ng/mL. Computed tomography (CT) scan of the abdomen demonstrated extensive hepatic metastasis with portal adenopathy (Image 1). A biopsy from a liver lesion showed invasive moderately differentiated adenocarcinoma with immunohistochemistry stains suggesting cholangiocarcinoma. The patient was started on chemotherapy with folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX) while arranging for further diagnostic testing. He received the first dose of cycle one, but at the time of day 14 dose, he presented to the emergency room with dyspnea on exertion, and severe bilateral lower extremities edema. His blood tests on the first day of chemotherapy and on the fourteenth day are summarized in Table 1. He was diagnosed with TLS and treatment with intravenous rasburicase was started with minimal improvement in his electrolyte abnormalities. Continuous renal replacement therapy (CRRT) was then restarted. During the next week, his condition improved clinically, and he was transitioned to intermittent hemodialysis. Discussion: TLS is a life-threatening complication of various malignancies and their treatments. The case we presented is for an unfortunate 33-year-old man who was found to have metastatic cholangiocarcinoma. Laboratory evaluation two weeks after initiating FOLFOX therapy revealed severe hyponatremia, hyperkalemia, hyperuricemia, elevated LDH, and acute kidney injury meeting criteria for TLS. The patient responded well to treatments directed at his TLS. Gastroenterologists and hepatologists who may commonly treat patients with solid colon and liver malignancies should not forget that TLS is a medical emergency that can still occur in our patient population. Prompt diagnosis and treatment is vital for successful treatment of this syndrome.

PubMed ID

Not assigned.

Volume

116

Issue

SUPPL

First Page

S1170

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