Spontaneous Tumour Lysis Syndrome in Mantle Cell Lymphoma: A Case Study

Tumour lysis syndrome (TLS) is an onco-metabolic emergency seen in rapidly proliferative malignancies resulting from the destruction of tumour cells, resulting in an electrolyte and metabolic derangement. TLS is usually associated with high-grade haematological malignancies and rarely with solid tumours. TLS can be therapy induced or might occur spontaneously. Here, we present a case of a 61-year-old male patient with newly diagnosed mantle cell lymphoma (MCL) admitted for elective chemotherapy, who went into sudden spontaneous tumour lysis before the administration of cytotoxic chemotherapy. The laboratory investigations were consistent with hyperkalaemia, hyperuricaemia, hyperphosphatemia and acute kidney injury. The patient was managed with aggressive intravenous hydration and rasburicase, and his hyperkalaemia was managed in the ward. He was taken to the intensive care unit (ICU) for consideration of haemofiltration. Unfortunately, the patient went into multi-organ failure soon after and died. This case emphasises the need to recognise and treat this complication quickly as it can have fatal consequences. Additionally, it stresses the necessity to vigorously screen patients admitted with malignancy and high tumour burden for TLS, even when they do not receive cytotoxic treatment. TLS management includes adequate hydration, the use of uric acid-lowering therapies and minimisation of potassium intake.