What happened, in summary

A 63-year-old woman had been diagnosed with Stage III grade 3 serous ovarian cancer in 2001. She underwent hysterectomy with removal of both ovaries and fallopian tubes, followed by 6 cycles of carboplatin and docetaxel. Five months later, the cancer returned with small lung metastases and para-aortic lymph node disease. Liposomal doxorubicin was stopped after 3 cycles because of toxicity, and 9 cycles of topotecan produced a partial response. Her disease then remained stable for 9 years.

In 2012, increasing shortness of breath led to imaging that showed extensive recurrent disease, including new lung nodules, mediastinal disease, retroperitoneal lymph nodes, and tumor extending through major blood vessels into the right side of the heart.

She restarted chemotherapy with carboplatin and paclitaxel. Two days after the first treatment, she developed tumor lysis syndrome with acute kidney injury and major metabolic abnormalities. Despite intensive supportive care, her condition worsened with respiratory failure, liver injury, clotting abnormalities, and bowel ischemia. The case documents a severe complication during treatment of rapidly progressive metastatic recurrence.