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Abstract

Introduction

Tumor lysis syndrome is a well-described phenomenoncharacterized by elevated serum levels of calcium, uric acid,potassium, phosphate, and lactate dehydrogenase due to lysis oftumor cells and release of intracellular contents. Acute kidneyinjury may occur as the result of precipitation of intrarenalcalcium phosphate salts related to the rapid destruction ofa large number of tumor cells.1 Tumor lysis syndrome mostoften occurs during induction chemotherapy for aggressiveleukemia or lymphoma, particularly those with large tumorburden.1 While tumor lysis syndrome is more commonly seenin patients receiving chemotherapy, it can occur spontaneouslyand has been described in aggressive malignancies, such asAML,2 Burkitt’s lymphoma in children1 and adults,3 and insolid malignancies, such as breast cancer.4 This case describes apatient who presented with a neck mass and spontaneous tumorlysis syndrome.

Case Presentation

A 76-year-old male with a past medical history of hypertension,hyperlipidemia, and coronary artery disease presented withepistaxis and a neck mass that was first noted four weeks prior topresentation. In addition, the patient noticed gingival bleedingwhen brushing his teeth, malaise, decreased appetite, and nightsweats, all of which developed during the previous week. Hisexam was significant for an ulcer with scab on his left buccalmucosa, a 6-cm left neck mass that was firm and non-tender,and several areas of ecchymosis on his arms bilaterally. Therewas no axillary or inguinal lymphadenopathy. The remainder ofthe exam was unremarkable.

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