Spontaneous Tumor Lysis Syndrome in Refractory Metastatic Esophageal Adenocarcinoma Presenting With Septic Shock

Spontaneous tumor lysis syndrome (STLS) presents a diagnostic challenge when it occurs in patients with advanced solid malignancies and concurrent critical illness.We present a case of STLS in a 30-year-old man with refractory metastatic esophageal adenocarcinoma who presented with hypotension, anuria, and severe metabolic derangements.Laboratory evaluation demonstrated hyperuricemia (18.1 mg/dL), hyperkalemia (7.6 mmol/L), hyperphosphatemia (7.8 mg/dL), and acute kidney injury.Ionized calcium was also low at 1.03 mmol/L despite hypoalbuminemia, with laboratory and clinical findings consistent with TLS by Cairo-Bishop thresholds.His final treatment was initiated 19 days before presentation, with the continuous fluorouracil infusion completed approximately 17 days before presentation, placing the presentation well outside the conventional treatment-related timeframe.His course was complicated by septic shock secondary to methicillin-sensitive Staphylococcus aureus bacteremia.Despite supportive care and rasburicase administration, he developed multiorgan failure and was transitioned to hospice.This case highlights the rare occurrence of spontaneous TLS in metastatic esophageal adenocarcinoma and emphasizes the importance of early recognition and consideration in any patient with high tumor burden.