{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T06:47:57Z","timestamp":1782456477944,"version":"3.54.5"},"reference-count":17,"publisher":"Croatian Society for Medical Biochemistry and Laboratory Medicine","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biochem. med. (Online)"],"published-print":{"date-parts":[[2026,6,15]]},"abstract":"<jats:p>Tumour lysis syndrome (TLS) is an oncologic emergency usually arising after chemotherapy administration, caused by a massive tumour breakdown and characterized by a specific laboratory and clinical findings. We present a case of TLS, both spontaneous and treatment related, in a 59-year-old woman with high grade B-cell lymphoma without apparent bulky disease on radiologic scans. The patient presented with acute kidney failure with marked hyperuricemia (2764 \u00b5mol\/L) and extremely high lactate dehydrogenase (LD) activity (13,770 U\/L). She was treated with rasburicase, corticosteroid pre-phase therapy, sequential chemotherapy and renal replacement therapy tailored to electrolytic disturbances. After initial resolution of spontaneous TLS, at the start of chemotherapy administration, she experienced systemic inflammatory response (SIRS) and therapy related TLS which included, amongst else, vast hyperphosphatemia (6.12 mmol\/L). Despite all intensive care treatment, patient went into multiorgan failure preceding lethal outcome. This case report confirms the value of laboratory parameters in establishing the diagnosis of TLS with LD as an indicator of massive tumour turnover. Due to a high risk of deleterious complications, management of extreme TLS cases challenges the current guidelines of TLS therapy. Modern treatment options such as targeted anticytokine therapy could potentially bring benefit in these specific circumstances.<\/jats:p>","DOI":"10.11613\/bm.2026.020901","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:09:43Z","timestamp":1775722183000},"page":"354-360","source":"Crossref","is-referenced-by-count":0,"title":["Tumour lysis syndrome in the setting of a high-grade B-cell lymphoma with primary bone marrow localization"],"prefix":"10.11613","volume":"36","author":[{"given":"Sandra","family":"Koji\u0107 Katovi\u0107","sequence":"first","affiliation":[{"name":"Department of Pathology and Cytology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar","family":"Ga\u0107ina","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomislav","family":"Brbli\u0107","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana","family":"Matijaca","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Novakovi\u0107 Coha","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"\u0106elap","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iva","family":"Ivanko","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josipa","family":"Josipovi\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, Catholic University of Croatia, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4885","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"key20260409080938_r1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1365-2141.2004.05094.x","article-title":"Tumour lysis syndrome: new therapeutic strategies and classification.","volume":"127","author":"Cairo","year":"2004","journal-title":"Br J Haematol"},{"key":"key20260409080938_r2","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1159\/000509643","article-title":"Spontaneous Tumor Lysis Syndrome.","volume":"13","author":"Wesem\u00fcller","year":"2020","journal-title":"Case Rep Oncol"},{"key":"key20260409080938_r3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.21037\/sci.2019.07.01","article-title":"Spontaneous tumor lysis syndrome in T-cell malignancy: two case reports.","volume":"6","author":"Roque","year":"2019","journal-title":"Stem Cell Investig"},{"key":"key20260409080938_r4","article-title":"Tumor Lysis Syndrome in Patients With Solid Tumors: A Systematic Review of Reported Cases.","volume":"14","author":"Alqurashi","year":"2022","journal-title":"Cureus"},{"key":"key20260409080938_r5","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1634\/theoncologist.2017-0147","article-title":"In-hospital outcomes of tumor lysis syndrome: a population-based study using the National Inpatient Sample.","volume":"22","author":"Durani","year":"2017","journal-title":"Oncologist."},{"key":"key20260409080938_r6","doi-asserted-by":"crossref","first-page":"221","DOI":"10.3109\/10428190903456959","article-title":"Prognostic significance of acute renal injury in acute tumor lysis syndrome.","volume":"51","author":"Darmon","year":"2010","journal-title":"Leuk Lymphoma"},{"key":"key20260409080938_r7","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1038\/s41392-024-01916-y","article-title":"Hyperuricemia and its related diseases: mechanisms and advances in therapy.","volume":"9","author":"Du","year":"2024","journal-title":"Signal Transduct Target Ther"},{"key":"key20260409080938_r8","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1111\/bjh.70092","article-title":"British Society for Haematology updated guidelines for the diagnosis and management of tumour lysis syndrome in adults and children with haematological malignancies: A focus on patient safety.","volume":"207","author":"Chan","year":"2025","journal-title":"Br J Haematol"},{"key":"key20260409080938_r9","unstructured":"National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin\u2019s Lymphomas \u2013 Supportive Care Section. Version 3.2025 [Internet]. 2025 Aug [cited 2025 Nov 04]. Available from: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/b-cell.pdf."},{"key":"key20260409080938_r10","unstructured":"Kent and Medway Cancer Collaborative. Guidelines for use of rasburicase in adult haematology and oncology patients [Internet]. 2024 [cited 2025 Nov 4]. Available from: https:\/\/www.kmcc.nhs.uk\/s3\/assets\/pharmacy\/guidelines-for-use-of-rasburicase-v7.pdf"},{"key":"key20260409080938_r11","unstructured":"Larson RA, Pui CH. Tumor lysis syndrome: Prevention and treatment. UpToDate [Internet]. 2025 Jul [cited 2025 Nov 04]. Available from: https:\/\/www.uptodate.com\/contents\/tumor-lysis-syndrome-prevention-and-treatment"},{"key":"key20260409080938_r12","unstructured":"Croatian Cooperative Group for Hematologic Diseases. Recommendations for systemic treatment of lymphoma Version 4.4. [Internet]. 2022 [cited 2025 Nov 4]. 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