Spontaneous tumor lysis syndrome in a patient with metastatic hepatocellular carcinoma

Objective: To report a case of spontaneous tumor lysis syndrome (STLS) of a solid tumor in a patient who had undiagnosed metastatic hepatocellular carcinoma. Clinical Presentation and Intervention: A 70-year-old man with a medical history of alcohol abuse, withdrawal seizure and hypertension presented to the emergency department after being found unresponsive by his landlord. The patient had a bulky mass in the liver, classic laboratory abnormalities, oliguric renal failure and elevated alpha fetoprotein. He had never been treated with cytotoxic therapy. He was treated aggressively with fluid resuscitation and sodium bicarbonate, but he continued to be oliguric and the deterioration of his renal function also continued. Due to a minimal response to treatment and a poor prognosis, he was discharged to hospice for palliative care. Conclusion: This case showed that STLS should be in the differential diagnosis of a patient who has malignant disease and has developed classic laboratory abnormalities and renal failure even without previous cytotoxic therapy.