Fulminant tumour lysis syndrome: A case report

Abstract

A 14 years old Malay boy with fatal tumour lysis syndrome (TLS) is described. He was admitted with a two weeks history of a bleeding tendency and high grade fever. He was found to have lymphadenopathy and hepatosplenomegaly, and investigations confirmed him to have T-cell acute lymphoblastic leukaemia with a mediastinal mass and a high presenting white cell count (158x109 /I). Eight hours after he was given the first doses of intravenous chemotherapy, he developed features of severe TLS, i.e. marked hyperkalaemia, hyperphosphataemia, hypocalcaemia, metabolic acidosis and renal impairment with pulmonary oedema. He died two hours later. Risk factors for the development of TLS, and ways of preventing and treating it are discussed.