Tumor lysis syndrome in a patient with metastatic melanoma treated with nivolumab
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CASE REPORT
Tumor lysis syndrome in a patient with metastatic melanoma treated with nivolumab Saiho Sugimoto1 · Takeshi Terashima1 · Tatsuya Yamashita1 · Noriho Iida1 · Masaaki Kitahara1 · Yuji Hodo2 · Tetsuro Shimakami1 · Hajime Takatori1 · Kuniaki Arai1 · Kazunori Kawaguchi1 · Kazuya Kitamura1 · Taro Yamashita1 · Yoshio Sakai1 · Yukihiro Shirota2 · Katsuaki Sato3 · Eishiro Mizukoshi1 · Masao Honda1 · Kenichi Harada4 · Shuichi Kaneko1 Received: 22 April 2020 / Accepted: 14 June 2020 © Japanese Society of Gastroenterology 2020
Abstract A 79-year-old man with metastatic melanoma of the right maxillary sinus and multiple liver metastases received a single dose of nivolumab. Eight days later, he experienced impaired consciousness, accompanied by abnormal laboratory and electrocardiographic findings. He was therefore diagnosed with tumor lysis syndrome (TLS). Laboratory and electrocardiographic findings improved immediately after continuous hemodiafiltration; however, he died 22 days after receiving nivolumab. Autopsy revealed massive tumor necrosis in the liver. There are few case reports of TLS associated with immune checkpoint inhibitors, indicating that we should be prepared to manage especially in a patient with liver involvement of high tumor burden. Keywords Metastatic melanoma · Nivolumab · Tumor lysis syndrome · Hepatic fairure · Liver metastases
Introduction Tumor lysis syndrome (TLS) represents an oncological emergency. Although it occurs most often in patients with chemotherapy-sensitive hematological malignancies such as non-Hodgkin lymphoma or acute leukemia, patients with solid tumors experience an increased incidence of TLS because of the successful development of more effective antitumor agents that induce massive cytolysis of tumor cells [1]. Several new agents such as immune checkpoint inhibitors, BRAF inhibitors, and MEK inhibitors confer clinical benefits upon patients with metastatic melanoma [2, * Tatsuya Yamashita ytatsuya@m‑kanazawa.jp 1
Department of Gastroenterology, Kanazawa University Hospital, 13‑1 Takara‑Machi, Kanazawa, Ishikawa 920‑8641, Japan
2
Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa 920‑0353, Japan
3
Department of Pathology, Noto General Hospital, Nanao, Ishikawa 926‑0816, Japan
4
Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa 920‑8640, Japan
3]. However, there are few reports of TLS in patients with malignant melanoma. Here we report the onset of TLS in a patient with massive liver lesions of metastatic melanoma after treatment with nivolumab.
Case report A 79-year-old man visited a hospital because of syncope and epigastralgia. Enhanced computed tomography (CT) revealed multiple liver tumors with spontaneous tumor rupture. He immediately underwent transcatheter arterial embolization to achieve hemostasis. Percutaneous biopsy revealed that the liver tumors were malignant melanomas, and the patient was referred to our hospital for further treatment. The patient started r
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