Tumor lysis syndrome (TLS) is a hematological emergency. This syndrome is characterized by metabolic derangements such as hyperkalemia and hypocalcemia, which result from rapid lysis of cells, especially rapidly growing tumors, after the initiation of chemotherapy. It is rarely seen in chronic myeloid leukemia (CML) and has not been previously reported to be triggered by coronavirus disease 2019 (COVID-19) infection. We report a case of a 45-year-old male, a known case of CML in the chronic phase, who presented with fatigue and abdominal pain for four days. Initial laboratory results were consistent with leukocytosis and positive COVID-19 antigen. The patient was started on intravenous fluids and hydroxyurea; however, over the next few days, he deteriorated quickly and developed oliguric acute kidney injury (AKI) with electrolyte disturbance consistent with TLS. The patient was shifted to the intensive care unit and underwent one sustained low-efficiency dialysis (SLED) session and received rasburicase. Over the next few days, the patient started to improve and was discharged in good shape. Although CML rarely presents with TLS, physicians should monitor their patients closely, especially those who have concurrent COVID-19 infection, as this condition may result in lethal sequelae such as AKI, severe arrhythmias, and multiorgan failure. Additionally, early detection and treatment lead to a better prognosis.
Keywords: acute kidney injury; cairo and bishop classification; rasburicase; tumor-lysis syndrome; tumor-lysis syndrome in chronic myeloid leukemia; tumor-lysis syndrome in covid-19 infection.
Copyright © 2022, Waseem Hajjar et al.