Two Rare Clinical Spectrums in a Hodgkin Lymphoma Patient: Super-acute Tumor Lysis Syndrome and Syndrome of Inappropriate Antidiuretic Hormone

Tumor lysis syndrome (TLS) can be seen in hematological malignancies before and during treatment. Rapid tumor cell lysis by chemotherapy causes electrolyte abnormalities in patients, which can lead to organ failure and death. We aimed to present a case of a patient with super-acute TLS, which is not an expected finding in Hodgkin lymphoma patients. A 44-year-old male patient was admitted to the infectious diseases ward due to a fever of unknown origin. He had complaints of periodically recurring fevers, night sweats, fatigue, and weight loss for the last year. Excisional lymph node biopsy was performed because of the patient’s B symptoms and multiple lymphadenopathy. The patient’s excisional lymph node biopsy was reported as Classical Hodgkin lymphoma, mixed cellular type. Standard Hodgkin lymphoma chemotherapy: adriamycin-bleomycin-vinblastine-dacarbazine was planned after staging. However, the patient developed clinical and laboratory superacute TLS after bleomycin and vinblastine treatment. The patient could not receive adriamycin and dacarbazine treatment. The patient experienced a deterioration in general condition and seizures. During the follow-up, vinblastine-associated syndrome of inappropriate antidiuretic hormone was also observed while waiting for the general condition to improve before starting chemotherapy again. Both clinical conditions, which are rarely seen in patients with Hodgkin lymphoma, are potentially fatal. Treating physicians should be alert to the many manifestations of this potential Hodgkin lymphoma sequela.