Rasburicase-Induced Methemoglobinemia in a Patient with Aggressive Non-Hodgkin's Lymphoma

The American Journal of Case Reports
Mohammed A AlessaJames M Cunningham

Abstract

Rasburicase is a recombinant urate oxidase enzyme that converts uric acid to allantoin (an inactive and soluble metabolite that is readily excreted in urine). It is used for the management of tumor lysis syndrome (TLS) in cancer patients receiving chemotherapy. Although rasburicase is a generally safe and effective treatment, it can be associated with the rare and potentially severe complication of methemoglobinemia. Here, we report a case of rasburicase-induced methemoglobinemia in a patient who was diagnosed with aggressive non-Hodgkin's lymphoma. A 74-year-old man with aggressive non-Hodgkin's lymphoma was admitted for initiation of chemotherapy. Upon admission, the patient was found to have hyperkalemia, hyperuricemia, hyperphosphatemia, elevated LDH levels, and acute renal failure. As a result, he was diagnosed with TLS. Rasburicase 6 mg was administered intravenously over a period of 30 min to treat TLS. Later, methemoglobinemia developed, with requirements for oxygen supplementation. Multiple units of packed red blood cells were transfused for recurrent significant anemia secondary to his cancer co-morbidity. The patient was tested for glucose-6 phosphate dehydrogenase (G6PD) deficiency, which returned negative; therefor...Continue Reading

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Citations

Apr 28, 2016·Journal of Clinical Apheresis·Kathleen W Montgomery, Garrett S Booth
Sep 24, 2016·La Revue de médecine interne·A DupréUNKNOWN pour le Groupe de recherche en réanimation respiratoire en Onco-Hématologie (GrrrOH)
Jan 2, 2018·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Manzilat AkandeJoseph D Tobias
Oct 31, 2020·Journal of Pediatric Hematology/oncology·Ilaria PirronePaolo D'Angelo

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Methods Mentioned

BETA
biopsy
sedation

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