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Tumor lysis syndrome after capecitabine plus cisplatin treatment in advanced gastric cancer.

A 38-year-old man presented with a 1-month history of progressively worsening abdominal pain and fullness. He had no relevant previous medical history (including renal disease). On physical examination, a firm, tender hepatomegaly was palpable, which extended 11 cm below the costal margin of the right midclavicular line. Computed tomography scan of the thorax and abdomen showed gastric body wall thickening and extensive metastases with multiple hepatic lesions, mediastinal, subcarinal, both paratracheal, perigastric, and retroperitoneal lymphadenopathies (Fig 1). Esophagogastroduodenoscopy showed a 5-cm sized ulcerofungating mass on the wall of the lesser curvature of the gastric body (Fig 2). Endoscopic biopsy confirmed a histologic diagnosis of poorly differentiated adenocarcinoma (Fig 3A). Immunohistochemistry demonstrated strong positivity for cytokeratin (Fig 3B), and negativity for -fetoprotein, beta-human chorionic gonadotropin (hCG), and placental alkaline phosphatase. Laboratory testing revealed ALT level of 360 U/L (normal range, 0 to 40 U/L), AST of 53 U/L (normal range, 0 to 40 U/L), uric acid was 7.4 mg/dL (normal range, 3.0 to 7.0 mg/dL), and lactate dehydrogenase was 14,088 U/L (normal range, 101 to 202 U/L). Serum creatinine level was 1.0 mg/dL (normal range, 0.7 to 1.4 mg/dL). A diagnosis of advanced gastric cancer (AGC) with multiple metastases in liver and lymph nodes of abdomen and chest was made, and the patient began treatment with capecitabine (1,250 mg/m orally twice daily on day 1 through 14) plus cisplatin (60 mg/m intravenously on day 1) in a 3-week cycle. Three days after initiating chemotherapy,