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

This article has now been updated. Please use the final version.

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
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Shin-ichiro Fujiwara
Department 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
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Rui Murahashi
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Hirotomo Nakashima
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Sae Matsuoka
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Takashi Ikeda
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Yumiko Toda
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Shinichiro Kawaguchi
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Takashi Nagayama
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Kento Umino
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Daisuke Minakata
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Hirofumi Nakano
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Kaoru Morita
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Ryoko Yamasaki
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Masahiro Ashizawa
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Chihiro Yamamoto
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Kaoru Hatano
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Kazuya Sato
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Ken Ohmine
Department of Hematology, Department of Medicine, Jichi Medical University, Japan
Yoshinobu Kanda
Department of Hematology, Department of Medicine, Jichi Medical University, Japan

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

JOURNAL OPEN ACCESS Advance online publication

Article ID: 9332-22

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

The final version of this article is now available: Vol. 61 (2022), No. 21 pp. 3271-3275

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.

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