Urine Xanthine Crystals in Hematologic Malignancies with Tumor Lysis Syndrome

Shoko Ito; Shin-ichiro Fujiwara; Tomoaki Yoshizawa; Kaori Hayatsu; Kaoru Sekiguchi; Rui Murahashi; Hirotomo Nakashima; Sae Matsuoka; Takashi Ikeda; Yumiko Toda; Shinichiro Kawaguchi; Takashi Nagayama; Kento Umino; Daisuke Minakata; Hirofumi Nakano; Kaoru Morita; Ryoko Yamasaki; Masahiro Ashizawa; Chihiro Yamamoto; Kaoru Hatano; Kazuya Sato; Ken Ohmine; Yoshinobu Kanda

doi:10.2169/internalmedicine.9332-22

CASE REPORTS

Urine Xanthine Crystals in Hematologic Malignancies with Tumor Lysis Syndrome

Shoko Ito, Shin-ichiro Fujiwara, Tomoaki Yoshizawa, Kaori Hayatsu, Kaoru Sekiguchi, Rui Murahashi, Hirotomo Nakashima, Sae Matsuoka, Takashi Ikeda, Yumiko Toda, Shinichiro Kawaguchi, Takashi Nagayama, Kento Umino, Daisuke Minakata, Hirofumi Nakano, Kaoru Morita, Ryoko Yamasaki, Masahiro Ashizawa, Chihiro Yamamoto, Kaoru Hatano, Kazuya Sato, Ken Ohmine, Yoshinobu Kanda

Author information

Shoko Ito
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Shin-ichiro Fujiwara
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Department of Transplantation and Transfusion, Jichi Medical University, Japan
Tomoaki Yoshizawa
Department of Clinical Laboratory Medicine, Jichi Medical University, Japan
Kaori Hayatsu
Department of Clinical Laboratory Medicine, Jichi Medical University, Japan
Kaoru Sekiguchi
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Rui Murahashi
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Hirotomo Nakashima
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Sae Matsuoka
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Takashi Ikeda
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Yumiko Toda
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Shinichiro Kawaguchi
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Takashi Nagayama
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Kento Umino
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Daisuke Minakata
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Hirofumi Nakano
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Kaoru Morita
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Ryoko Yamasaki
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Masahiro Ashizawa
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Chihiro Yamamoto
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Kaoru Hatano
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Kazuya Sato
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Ken Ohmine
Division of Hematology, Department of Medicine, Jichi Medical University, Japan
Yoshinobu Kanda
Division of Hematology, Department of Medicine, Jichi Medical University, Japan

Keywords: xanthine crystals, tumor lysis syndrome, febuxostat, allopurinol, rasburicase

JOURNAL OPEN ACCESS
Supplementary material

2022 Volume 61 Issue 21 Pages 3271-3275

DOI https://doi.org/10.2169/internalmedicine.9332-22

Browse “Advance online publication” version

Details

Abstract

Tumor lysis syndrome (TLS) is a metabolic disorder caused by massive tumor lysis. Hypouricemic agents are administered to prevent TLS-related hyperuricemia and renal failure. We experienced three cases of urine xanthine crystals during TLS in patients with hematologic malignancies who received prophylactic febuxostat. Yellowish and pinkish deposits were observed in urinary tract catheters and urinary bags. Urine microscopy revealed that the deposits were xanthine crystals. In rapid tumor lysis, inhibition of xanthine oxidase can cause xanthine accumulation and urine xanthine crystallization. During TLS, urine xanthine crystals may be overlooked, so careful observation and management are required to avoid xanthine nephropathy.

Corresponding author

Register with J-STAGE for free!