Tumor Lysis Syndrome in a 30-Year-Old Male With Metastatic Seminoma: A Case Report

A 30-year-old Hispanic male was admitted to the medicine service for a growing left testicular and pan-abdominal mass. His prior medical and surgical history was unremarkable. CT imaging showed a retroperitoneal and intraperitoneal mass. Testicular ultrasound revealed an 11.3 cm left scrotal mass. The biopsy of both masses was positive for metastatic seminoma. The patient underwent a left radical orchiectomy and was initiated on five cycles of bleomycin, etoposide, and cisplatin. Prior to the initiation of chemotherapy, the patient met the Cairo-Bishop criteria for tumor lysis syndrome (TLS) with several electrolyte derangements. He did not have clinical symptoms secondary to TLS and no EKG changes were observed. The patient was initiated on IV normal saline as well as allopurinol, which stabilized both the uric acid and potassium levels. Patients diagnosed with solid tumor malignancy should be monitored for TLS, even prior to initiation of chemotherapy, in the setting of extensive tumor burden, as the consequences of this syndrome can be rapidly fatal.