{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:02:15Z","timestamp":1785322935890,"version":"3.55.0"},"reference-count":14,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,6]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>A man in his late 60s presented with rapidly progressive dyspnoea and inspiratory stridor requiring emergency intubation. Bronchoscopy demonstrated critical bilateral main bronchial compression, and biopsy confirmed small cell lung cancer (SCLC) with bulky mediastinal disease. Deliberately dose-reduced carboplatin and etoposide were initiated. Despite prophylactic hydration and allopurinol, he developed fulminant tumour lysis syndrome (TLS) approximately 72 hours after chemotherapy initiation, meeting Cairo-Bishop criteria and died despite rasburicase and maximal supportive care.<\/jats:p>\n                  <jats:p>TLS is rare in solid tumours, and in SCLC, it is typically reported following spontaneous lysis or full-dose chemotherapy. This case demonstrates that even dose-reduced chemotherapy, when used emergently in bulky, chemosensitive disease, can precipitate catastrophic TLS. It highlights critical airway compromise in SCLC as a high-risk phenotype and highlights the need for heightened vigilance and anticipatory management when balancing urgent airway stabilisation against systemic therapy.<\/jats:p>","DOI":"10.1136\/bcr-2026-272527","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T14:20:42Z","timestamp":1776694842000},"page":"e272527","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Tumour lysis syndrome following deliberately dose-reduced chemotherapy in extensive-stage small cell lung cancer with critical airway obstruction"],"prefix":"10.1136","volume":"19","author":[{"given":"Sze Kye","family":"Teoh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hospital Ampang, Ampang Jaya, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen Shen","family":"Wong","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Teknologi Mara Fakulti Perubatan, Sungai Buloh, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhashini","family":"Ganapathy","sequence":"additional","affiliation":[{"name":"Department of Pathology, Serdang Hospital, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audi Adawiah","family":"Sulaiman Shah","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hospital Kuala Lumpur, Federal Territory of Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"2026042007201068000_19.4.e272527.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1809064"},{"key":"2026042007201068000_19.4.e272527.2","first-page":"100530","article-title":"Tumor lysis syndrome in patients with solid tumors: a systematic review","volume":"31","author":"Alqurashi","year":"2022","journal-title":"Cancer Treat Res Commun"},{"key":"2026042007201068000_19.4.e272527.3","doi-asserted-by":"publisher","DOI":"10.1159\/000324791"},{"key":"2026042007201068000_19.4.e272527.4","doi-asserted-by":"crossref","first-page":"452","DOI":"10.4172\/1948-5956.1000133","article-title":"Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Small Cell Carcinoma of the Lung","volume":"04","author":"Padhi","year":"2012","journal-title":"JCST"},{"key":"2026042007201068000_19.4.e272527.5","doi-asserted-by":"publisher","DOI":"10.1159\/000474937"},{"key":"2026042007201068000_19.4.e272527.6","unstructured":"Mutis Alan A , Karabulut N , Aydan M . Spontaneous tumor lysis syndrome in small cell lung cancer. Respir Med Case Rep 2020;31."},{"key":"2026042007201068000_19.4.e272527.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2004.05094.x"},{"key":"2026042007201068000_19.4.e272527.8","unstructured":"University hospital southampton sclc chemotherapy protocol."},{"key":"2026042007201068000_19.4.e272527.9","unstructured":"Mitchell S . n.d. Cairo Recommendation for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS consensus."},{"key":"2026042007201068000_19.4.e272527.10","unstructured":"Koura S S , Parekh V V , Parikh AD AD . Another spontaneous TLS SCLC case treated with early rasburicase and continuous renal replacement therapy with metabolic improvement but eventual comfort-care transition. Cureus 2023."},{"key":"2026042007201068000_19.4.e272527.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0904569"},{"key":"2026042007201068000_19.4.e272527.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2006.09.005"},{"key":"2026042007201068000_19.4.e272527.13","doi-asserted-by":"crossref","unstructured":"Vodopivec DM , Rubio JE , Fornoni A , et al . An unusual presentation of tumor lysis syndrome in a patient with small cell lung cancer: a case report and review of the literature. Case Rep Oncol Med 2012;610969. doi:10.1155\/2012\/468452","DOI":"10.1155\/2012\/468452"},{"key":"2026042007201068000_19.4.e272527.14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.26.8896"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272527","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T14:20:52Z","timestamp":1776694852000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,20]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2026-272527"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272527","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}