Steroid-induced tumor lysis syndrome in solid tumors: A case report and review of the literature.

Tumor lysis syndrome (TLS) arises from the uncontrolled release of intracellular contents into the bloodstream. Generally associated with hematologic malignancies, TLS has also been reported in aggressive solid cancers. Corticosteroids are known triggers of cell lysis in leukemias and lymphomas, but less evidence exists to suggest steroids cause TLS in solid malignancies. We present a case of a 43-year-old smoker with dyspnea, cough, and chest pain. Endobronchial biopsy confirmed the diagnosis of extensive-stage small-cell carcinoma. He remained intubated due to airway edema and was started on dexamethasone. Prior to steroid administration, his blood chemistry values were within reference ranges. The following day, he met both laboratory and clinical Cairo-Bishop criteria for TLS. Despite IV hydration and rasburicase, he worsened and was transitioned to comfort care. This case suggests one of the clearest associations between steroid administration and TLS in a solid tumor. We systematically explored PubMed for cases of TLS in solid tumors and evaluated these for steroid use prior to diagnosis. Of the 252 included articles, 20 described corticosteroid use before the onset of TLS, with only 10 explicitly suggesting steroids may have been causative. While rare in solid tumors, TLS should be considered in any aggressive solid malignancy. A high index of suspicion is essential as early recognition and management of TLS are associated with improved outcomes. We encourage particular attention to be paid after steroids have been administered.