Acute tumor lysis syndrome with choriocarcinoma

A 52-year-old man with retroperitoneal nodal, lung, and liver metastases fr om choriocarcinoma received chemotherapy with etoposide, cisplatin, and ble omycin. Within 48 hours of starting treatment, he had hypotension, hypoxemi a, and anuria. Laboratory values showed hyperuricemia, hyperkalemia, hyperp hosphatemia, hypocalcemia, and metabolic acidosis. He was placed on mechani cal ventilation, and hemodialysis was instituted, with marked improvement i n renal function, A second, shortened course of chemotherapy with carboplat in and etoposide was given 21 days later. However, on hospital day 48, the patient died of progressive pulmonary insufficiency and cardiac arrest. Thi s represents the first reported case of acute tumor lysis syndrome after sy stemic chemotherapy for advanced nonseminomatous germ cell cancer.