Spontaneous Tumor Lysis Syndrome in a Thoracic Burkitt Lymphoma: A Case Report

Burkitt lymphoma has a high proliferation rate and a significant risk of tumor lysis syndrome. Risk stratification and early identification are imperative since it is an oncological emergency. We report the case of a 20-year-old woman, without relevant past medical history, admitted to the Emergency Department with a three-week history of fatigue, chest discomfort, productive cough, night sweats, myalgia, odynophagia, and holocranial headache. Laboratory findings included lactic acidosis, elevation of inflammatory markers, and high D-dimer levels. Computed tomography angiography identified a large mediastinal mass with critical compression of the right pulmonary artery. Subsequently, the patient developed spontaneous tumor lysis syndrome with hemodynamic and metabolic instability. Biopsy of the lesion revealed a Burkitt lymphoma with a ki67 of 100%, an unexpected diagnosis since sporadic Burkitt Lymphoma is atypical in mediastinal location. Despite intensive hydration, rasburicase, and dexamethasone, progression to cardiogenic and obstructive shock required multiorgan support in the intensive care unit. After initial hemodynamic stabilization, targeted chemotherapy was initiated, but the patient's condition further worsened, followed by bone marrow aplasia, refractory shock, and death. The challenge of recognizing a serious illness in an apparently healthy young patient is highlighted, as well as maintaining a high level of suspicion of tumor lysis syndrome even in atypical circumstances.