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

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.