Rare Multiple Organ Failure Caused by Tumor Lysis and Subsequent Fatal Sepsis After Novel Salvaged Chemotherapy of Rituximab in a Diffuse Large B-cell Lymphoma Patient: A Case Report

Background: Tumor lysis syndrome (TLS) ranges from mild asymptomatic electrolyte derangement to severe organ dysfunction, is rarely associated with diffuse large B-cell Lymphoma (DLBCL). Standard chemotherapy of DLBCL is usually for clinical stable patients, however, it is still unclear for those in critical care situation with organ dysfunction. Case presentation: Here, we presented a rare case of aggressive bcl-2 and -myc double-positive DLBCL patient, 59-year-old, male, who rapidly progressed to severe multiple organ failure because of spontaneous TLS, and especially hepatic failure is very uncommon. Although the comprehensive treatments inclusive of early glucocorticoid usage, a stent implantation in superior vena cava, pleural and pericardial puncture drainage, anti-shock, non-invasive ventilator support, continuous renal replacement treatment (CRRT), plasma exchange and antibiotics alleviated or inverted the multiple organ failure, the patient was worsened to septic shock and died on the 12th day after new salvage chemotherapy regime with rituximab and cyclophosphamide under CRRT protection. Conclusions: The current case demonstrated a useful treatment framework to this kind of patient. We should cautiously give glucocorticoid to the patient suspected of lymphoma with high tumor burden. The comprehensive treatments for organ function supporting, especially CRRT, play a crucial role in the recovery of multiple organ failure. In addition, the optimal time and regimen choosing of rescue chemotherapy in severe DLBCL patients still remains a long way to define.