# A Case of Spontaneous Tumor Lysis Syndrome With Acute Kidney Injury and the Timing of Chemotherapy

## TL;DR

A patient with lymphoma experienced spontaneous tumor lysis syndrome and kidney injury, but recovered with dialysis and adjusted treatment.

## Contribution

The paper presents a rare case of spontaneous TLS with severe AKI and discusses optimal chemotherapy timing.

## Key findings

- The patient's metabolic imbalances and kidney function improved with hemodialysis and febuxostat.
- Dose-adjusted chemotherapy was safely administered after stabilization.
- The case highlights management strategies for TLS with severe AKI.

## Abstract

Tumor lysis syndrome (TLS) is an oncological emergency that can lead to acute kidney injury (AKI), cardiac arrhythmias, seizures, and death. TLS typically arises after initiation of chemotherapy. However, spontaneous TLS (STLS) can occur rarely. Here, we present the case of a 56-year-old male with HIV-associated stage IV diffuse large B-cell lymphoma, who presents with STLS with severe AKI. With hemodialysis, febuxostat, and dose-adjusted chemotherapy, successful resolution of metabolic derangements and return of his baseline kidney function was achieved. Our case aims to provide insight into when to initiate chemotherapy in STLS patients with severe AKI.