Yeungnam Univ J Med.  2015 Jun;32(1):47-49. 10.12701/yujm.2015.32.1.47.

Tumor lysis syndrome following sorafenib treatment in hepatocellular carcinoma

• Kim SY
• Kim HY
• Kim YS
• Lee SM
• Kim CW

• KMID: 2138644
• DOI: http://doi.org/10.12701/yujm.2015.32.1.47

Abstract

Sorafenib is indicated for the treatment of advanced hepatocellular carcinoma (HCC), but although rare, tumor lysis syndrome (TLS) can be fatal in HCC patients with a large tumor burden. The authors describe the case of a 55-year-old hepatitis B carrier who visited our clinic with progressive dyspnea for 3 weeks. Chest and abdominal computed tomography revealed a huge HCC in the left lobe of the liver with invasion of the inferior vena cava, right atrium, and pulmonary arteries. After 8 days of sorafenib administration, TLS was diagnosed based on the characteristic findings of hyperuricemia, hyperkalemia, and acute kidney injury with massive tumor necrosis by follow-up imaging. Despite discontinuation of sorafenib and supportive care, the patient's clinical course rapidly deteriorated. The authors describe a rare but fatal complication that occurred soon after sorafenib initiation for HCC. Careful follow-up is required after commencing sorafenib therapy for the early diagnosis and management of TLS.

Keyword

Hepatocellular carcinoma; Sorafenib; Tumor lysis syndrome

MeSH Terms

Acute Kidney Injury
Carcinoma, Hepatocellular*
Dyspnea
Early Diagnosis
Follow-Up Studies
Heart Atria
Hepatitis B
Humans
Hyperkalemia
Hyperuricemia
Liver
Middle Aged
Necrosis
Pulmonary Artery
Thorax
Tumor Burden
Tumor Lysis Syndrome*
Vena Cava, Inferior