Fatal Tumor Lysis Syndrome Following [ 177 Lu]Lu-DOTA-TATE Therapy

We present a 69-year-old woman who developed a lethal tumor lysis syndrome (TLS) after a first cycle of [ 177 Lu]Lu-DOTA-TATE, administered to treat a well-differentiated metastatic lung carcinoid tumor with liver, bone, and splenic progression. The patient developed diarrhea and general status deterioration rapidly after the injection, anuria, progressive consciousness disorder, and finally death in 48 hours. Laboratory analysis showed significant renal function impairment, hyperuricemia, and hyperphosphatemia, confirming the diagnosis. This case highlights a rare but deadly side effect of [ 177 Lu]Lu-DOTA-TATE and the precautions to be taken before treating high tumor burden patients.