Tumor lysis syndrome after steroid therapy for anaphylaxis

A 36-year-old man with mediastinal lymphoblastic lymphoma achieved complete remission with chemotherapy. After 18 months he relapsed in a leukemic phase with hematuria due to thrombocytopenia. While receiving 10 units of random donor platelets, he had anaphylaxis, for which he received epinephrine, diphenhydramine, and intravenous methylprednisolone (125 mg), causing rapid tumor lysis with hyperuricemia, hyperphosphatemia, hypocalcemia, and a rise in creatinine. Treatment with allopurinol and high-volume alkaline diuresis led to recovery of normal renal function within 72 hours. Since steroids are cytotoxic to many leukemias and lymphomas, physicians prescribing transfusions or treating anaphylaxis in cancer patients should be aware of this life-threatening potential complication.