Metastatic gestational trophoblastic neoplasia complicated by tumor lysis syndrome, heart failure, and thyrotoxicosis: A case report

Samer Schuman, Matt Pearson, Joseph A. Lucci, Leo B. Twiggs

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Tumor lysis syndrome (TLS) is an extremely rare complication of solid tumors and is more frequently observed in patients with hematologic alignancies. This report describes a novel approach to the management of a rare case of TLS in metastatic gestational trophoblastic neoplasia (GTN). CASE: A 17-year-old female presented 8 weeks postpartum with severe anemia, thyrotoxicosis, and elevated serum β-human chorionic gonadotropin (β-hCG). Imaging studies confirmed metastatic GTN to the lungs. The patient developed grade 4 TLS after the first cycle of etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). She id not respond to standard treatment of aggressive hydration and allupurinol and continued to be in renal failure with elevated uric acid. A single dose of recombinant urate oxidase, rasburicase, rendered the uric acid level undetectable in 3 days and completely reversed the renal failure, avoiding hemodialysis. Three more cycles of EMA-CO were then administered. Subsequently, the patient developed congestive heart failure and was switched to single-agent actinomycin-D. β-hCG became negative after 5 cycles, and her ejection fraction returned to baseline. CONCLUSION: This is a rare case of TLS in the setting of metastatic GTN. To our knowledge this is the first reported case of utilizing rasburicase for the management of TLS in GTN.

Original languageEnglish
Pages (from-to)441-444
Number of pages4
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume55
Issue number10
StatePublished - Oct 1 2010

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Tumor Lysis Syndrome
Gestational Trophoblastic Disease
Thyrotoxicosis
Heart Failure
Dactinomycin
Carbon Monoxide
Uric Acid
Renal Insufficiency
Urate Oxidase
A 17
Vincristine
Etoposide
Chorionic Gonadotropin
Methotrexate
Cyclophosphamide
Postpartum Period
Renal Dialysis
Anemia
Lung
Serum

Keywords

  • Congestive heart failure
  • Gestational tro-phoblastic neoplasia
  • Rasburicase
  • Thyrotoxicosis
  • Tumor lysis syndrome

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Metastatic gestational trophoblastic neoplasia complicated by tumor lysis syndrome, heart failure, and thyrotoxicosis : A case report. / Schuman, Samer; Pearson, Matt; Lucci, Joseph A.; Twiggs, Leo B.

In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist, Vol. 55, No. 10, 01.10.2010, p. 441-444.

Research output: Contribution to journalArticle

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