Acute
tumour lysis syndrome (TLS) is a catastrophic complication of the treatment of certain neoplastic disorders. It most commonly occurs in association with
hematologic malignancies and appears a few hours to a few days after initiation of specific
chemotherapy, as the result from the release of intracellular components into the bloodstream due to abrupt malignant cell death. Acute spontaneous TLS is rare, and it has been described in
leukemia and
lymphoma and in some patients with solid
tumors prior to institution of
therapy. The syndrome is characterized by
hyperuricemia,
hyperphosphatemia,
hypocalcemia,
hyperkalemia, and acute oliguric or anuric
renal failure due to
uric acid precipitation within the tubules (acute
uric acid nephropathy) and to
calcium phosphate deposition in the renal parenchyma and vessels.We report a case of acute spontaneous TLS in a patient with
Crohn s disease treated with immunosuppressive drugs, who developed a
plasmocytoma, in which serum
uric acid concentration attained exceptionally high levels (44 mg/dL). The patient underwent acute oliguric
renal failure, which required treatment with
hyperhydration, urine alkalinization,
urate oxidase and
hemodialysis, with a fatal evolution.In conclusion, the present case report has several peculiarities: that of being one of the rare examples of spontaneous TLS, that of showing an exceptionally severe
hyperuricemia, probably the highest ever reported in the literature, and that of the possible increased risk of tumours in patients with
Crohn s disease taking inmunosuppressives and/or
TNF antagonists.