BACKGROUND: Tumor lysis syndrome (TLS) is a well-known complication after the treatment of hematologic malignancies, often occurring after cytotoxic therapy, with Burkitt lymphoma demonstrating a relatively high incidence of TLS. However, perioperative TLS is a rare phenomenon, typically associated with tumor dissection, biopsy procedures, and anesthesia induction. CASE PRESENTATION: A 14-year-old Korean male patient was diagnosed with Burkitt lymphoma, presenting with a left neck mass. The patient underwent chemoport insertion after starting chemotherapy on the day prior to surgery. The chemoport procedure itself was uncomplicated. However, following emergence from general anesthesia, the patient developed cardiac arrhythmia and electrolyte disturbances, prompting the diagnosis of TLS based on laboratory results and clinical findings. After the patient developed refractory ventricular tachycardia, laboratory tests revealed hyperkalemia and hypocalcemia. A cocktail treatment was promptly administered to manage the hyperkalemia-induced arrhythmia. Simultaneously, transthoracic echocardiography was performed to rule out surgical or anesthesia-related complications, which showed no abnormalities. Upon confirmation of TLS, standard management was initiated, including aggressive intravenous fluid therapy and administration of a xanthine oxidase inhibitor. The patient was transferred to the intensive care unit and fully recovered by the following day. The patient was considered at high risk for TLS, and both the surgical and anesthesiology teams were vigilant to its potential development. Due to the timely initiation of TLS management, the patient was transferred back to the ward on postoperative day 1. Chemotherapy was resumed as initially planned. CONCLUSION: TLS may be triggered by the stress associated with anesthetic emergence, a phenomenon that is rare but important to recognize in high-tumor-burden patients in the perioperative setting. Early suspicion and prompt management are crucial for positive outcomes.
Yeom et al. (Thu,) studied this question.