title: Severe Tumor Lysis Syndrome and Acute Pulmonary Edema Requiring Extracorporeal Membrane Oxygenation Following Initiation of Chemotherapy for Metastatic Alveolar Rhabdomyosarcoma.
abstract: We present an 8-year-old male with metastatic alveolar rhabdomyosarcoma (ARMS) who developed precipitous cardiopulmonary collapse with severe tumor lysis syndrome (TLS) 48 hr after initiation of chemotherapy. Despite no detectable pulmonary metastases, acute hypoxemic respiratory failure developed, requiring extracorporeal membrane oxygenation (ECMO). Although TLS has been reported in disseminated ARMS, this singular case of life-threatening respiratory deterioration developing after initiation of chemotherapy presented unique therapeutic dilemmas. We review the clinical aspects of this case, including possible mechanisms of respiratory failure, and discuss the role of ECMO utilization in pediatric oncology.
authors.affiliation: Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.|Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ethan
authors.initials: E
authors.lastname: Sanford
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Traci
authors.initials: T
authors.lastname: Wolbrink
authors.affiliation: Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mack
authors.affiliation: Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: R Grant
authors.initials: RG
authors.lastname: Rowe
mesh_terms: D000208:Acute Disease; D002648:Child; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D011654:Pulmonary Edema / Q000209:etiology / Q000473:pathology / Q000628:therapy; D018232:Rhabdomyosarcoma, Alveolar / Q000188:drug therapy* / Q000473:pathology; D015275:Tumor Lysis Syndrome / Q000209:etiology / Q000473:pathology / Q000628:therapy
keywords: ECMO; alveolar rhabdomyosarcoma; pediatric cancer; tumor lysis syndrome