ABSTRACT
BACKGROUND Advanced urothelial carcinoma has been associated with poor prognosis due to high resistance to chemotherapy and radiation until immunotherapeutic agents, such as atezolizumab, emerged as an option and have shown improved survival. However, atezolizumab is associated with side effects, which were mainly autoimmune. In this case study, we report on a rare case of atezolizumab-induced tumor lysis syndrome. CASE REPORT A 67-year-old female with a primary diagnosis of metastatic urothelial carcinoma who presented to the emergency department with generalized weakness associated with nausea and vomiting 8 days after her first cycle of atezolizumab. Laboratory values showed hyperphosphatemia, hyperuricemia, hypocalcemia, and acute kidney injury consistent with tumor lysis syndrome. CONCLUSIONS In our report, we highlight tumor lysis syndrome as a potential reaction to atezolizumab; a condition that requires prophylaxis and close laboratory monitoring.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Carcinoma, Transitional Cell/pathology , Tumor Lysis Syndrome/etiology , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/pathology , Aged , Antibodies, Monoclonal, Humanized/administration & dosage , Biopsy, Needle , Carcinoma, Transitional Cell/diagnostic imaging , Carcinoma, Transitional Cell/drug therapy , Disease Progression , Emergency Service, Hospital , Female , Hospice Care , Humans , Immunohistochemistry , Monitoring, Physiologic , Neoplasm Invasiveness/pathology , Neoplasm Staging , Tomography, X-Ray Computed/methods , Tumor Lysis Syndrome/physiopathology , Urinary Bladder Neoplasms/diagnostic imagingABSTRACT
BACKGROUND Thyrotoxic periodic paralysis (TPP) is a rare cause of acute paralysis, which if not promptly recognized and treated, can lead to significant morbidity and mortality. TPP can be precipitated by several factors, including a high carbohydrate diet and exercise. This report is of a rare case of TPP after epidural steroid injection in a young man, with a review of the literature of previous cases. CASE REPORT A 36-year-old Asian man presented to the emergency department with sudden onset of paralysis of all his limbs following epidural steroid injection for traumatic low back pain. At presentation, he was found to have severe hypokalemia of 1.8 mEq/L. Further investigations led to the diagnosis of hyperthyroidism and Graves' disease. In the process of correcting his potassium, there was an unexpected rebound hyperkalemia that was successfully corrected. He had a rapid recovery and an early discharge from hospital. CONCLUSIONS Although several factors can lead to paralysis after an epidural steroid injection, TPP should be considered in the differential diagnosis, especially in individuals who have predisposing factors of ethnicity and gender. If patients have undiagnosed hyperthyroidism on presentation, the diagnosis of TPP can be delayed or missed. In the management of patients with TPP, care should be taken when correcting potassium levels.