title: Tumor lysis syndrome in a patient with merkel cell carcinoma and provoked pathologic sequence of acute kidney injury, reduced clearance of carboplatin and fatal pancytopenia.
abstract: BACKGROUND
  Merkel cell carcinoma (MCC) is a rare, highly malignant cancer of the skin primarily affecting the elderly, with a tendency for local recurrence and regional lymph node metastasis. It is very unusual for this kind of tumor to induce clinically apparent tumor lysis syndrome (TLS) which is a consequence of spontaneous cytolysis or massive tumor cell lysis, beginning a few hours after the initiation of treatment.
  
  
  METHODS
  We report here on a patient with metastatic MCC, who developed TLS following combination chemotherapy with carboplatin and etoposide.
  
  
  CONCLUSIONS
  The evolving acute kidney injury (AKI) provoked a pathologic sequence of reduced renal clearance leading to protracted clearance of carboplatin and subsequent fatal pancytopenia. When AKI occurs in close association with the administration of carboplatin, the institution of rescue hemodialysis is recommended to decrease plasma carboplatin levels and avoid this lethal complication.
authors: Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel. talgrenader65@hotmail.com
authors: Tal
authors: T
authors: Grenader
authors: Linda
authors: L
authors: Shavit
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced*; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D016190:Carboplatin / Q000009:adverse effects* / Q000097:blood* / Q000627:therapeutic use; D015266:Carcinoma, Merkel Cell / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D010198:Pancytopenia / Q000097:blood / Q000139:chemically induced*; D012878:Skin Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin