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• W4387266164 abstract "SESSION TITLE: Critical Care Case Report Posters 25 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Lysis-tumor-syndrome is an oncology-metabolic emergency associated mostly with solid tumors; non-Hodgkin lymphoma is the most common. However, spontaneous-lysis-tumor-syndrome (SLTS), as the initial presentation of acute leukemia, is a rare disorder. CASE PRESENTATION: We present a 76-year-old female with a history of hypertension, pulmonary hypertension, and idiopathic pulmonary fibrosis on home-oxygen (O2) at 2-3 liters; she presented complaining of pressure-like chest pain radiating down from the neck, worsening baseline dyspnea, and sharp pain on swallowing, which started three days before admission. She denies fever, chills, vomiting, diarrhea, weight loss, or other symptoms. At arrival, her vital signs were unremarkable, besides needing O2 to maintain adequate saturation of 94%. While in the emergency department, the patient developed hypotension of 87/56mmHg, which resolved with 500 mL of normal saline. Electrocardiogram (EKG) showed sinus tachycardia with nonspecific T wave changes, but troponins were consecutively normal twice.Furthermore, initial blood work demonstrated leukocytosis with a white cell blood count (WBC) of 49K with an increase in immature-granulocyte; renal function and liver function were normal. Chest X-ray (CXR) showed chronic fibrotic findings; however, due to the concern of possible ongoing infection, she was started on antibiotics, but all cultures were later negative. Peripheral-blood-smear showed an increased number of WBC's with numerous monocytes, some atypical appearing, rare monocytic blasts with high nucleo-cytoplasm ratio and visible nucleoli, increased number of neutrophils, also some bands, metamyelocytes, and myelocytes, numerous nucleated red blood cells with dysplastic budding nuclei, moderate poikilocytosis, moderate polychromasia, decreased number of platelets with frequently large platelets. Therefore a bone marrow biopsy was performed. However, 12 hours after admission, her creatinine increased from 1.0 mg/dl to 2.4 mg/dl, with worsening respiratory status that needed to escalate O2 therapy to a high-flow-nasal cannula associated with jugular venous distention and chest pain. Subsequently, EKG showed diffuse ST segment elevation in all 12 leads; an echocardiogram showed pericarditis without signs of cardiac tamponade. A new CXR showed pulmonary congestion. Hence the patient was started on diuretics and colchicine.Eighteen hours after admission, the creatinine worsened to 2.5-mg/dl, uric-acid was 11-mg/dl (previously normal), and LDH was 1055-UI/L, phosphorus of 9.8-mg/dl, respectively calcium was 7.8-mg/dl (corrected with albumin), and potassium was 6.5-mEq/L. Therefore, SLTS was diagnosed. Nephrology was contacted to start appropriate treatment; however, the patient further decompensated and died after 20 hours after admission. Bone marrow biopsy results confirmed CMML in the blastic-phase. DISCUSSION: SLTS is a rare entity; our patient met the clinical and symptomatic criteria for SLTS in the context of CMML in a blastic phase which most likely triggered the SLTS. SLTS is caused by the burden and metabolization of the cancer cells, and without treatment, this can be fatal like it was with our patient, who unfortunately died not even 24 hours after admission. Treatment of SLTS is aimed at preventing hyperkalemia and hypocalcemia avoiding cardiac arrhythmias, and if needed, renal replacement therapy. CONCLUSIONS: SLTS is a rare entity; however, high suspicious should be maintained and appropriate treatment instituted even with clinical suspicion because outcomes tend to be fatal REFERENCE #1: Howard SC, Jones DP, Pui CH. The Tumor Lysis Syndrome. N Engl J Med. 12 de mayo de 2011;364(19):1844-54. REFERENCE #2: Gangireddy M, Shrimanker I, Nookala VK, Peroutka KA. Spontaneous Tumor Lysis Syndrome in Diffuse Large B-cell Lymphoma: Early Diagnosis and Management. Cureus. 11(5):e4679. REFERENCE #3: Mirrakhimov AE, Voore P, Khan M, Ali AM. Tumor lysis syndrome: A clinical review. World J Crit Care Med. 4 de mayo de 2015;4(2):130-8. DISCLOSURES: No relevant relationships by Coralia Castillo No relevant relationships by Garry Francis-Morel No relevant relationships by Nehemias Guevara No relevant relationships by Jamil Ibrahim" @default.
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• W4387266164 date "2023-10-01" @default.
• W4387266164 modified "2023-10-17" @default.
• W4387266164 title "CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) PRESENTING WITH SPONTANEOUS LYSIS TUMOR SYNDROME: A CASE REPORT" @default.
• W4387266164 doi "https://doi.org/10.1016/j.chest.2023.07.1611" @default.
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