Information from xanthine crystals appearing in the urine of a patient with hematologic malignancy

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  • YOSHIZAWA Tomoaki
    Department of Clinical Laboratory Medicine, Jichi Medical University Hospital
  • HAYATSU Kaori
    Department of Clinical Laboratory Medicine, Jichi Medical University Hospital
  • TSUCHIYA Kozue
    Department of Clinical Laboratory Medicine, Jichi Medical University Hospital
  • CHIKUGO Fumiko
    Department of Clinical Laboratory Medicine, Jichi Medical University Hospital
  • HIDAKA Yusuke
    Department of Clinical Laboratory Medicine, Jichi Medical University Hospital

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  • 血液腫瘍患者の尿中に顆粒状物質の集塊を認め，その後キサンチン結晶が出現した1症例
  • ケツエキ シュヨウ カンジャ ノ ニョウチュウ ニ カリュウジョウ ブッシツ ノ シュウカイ オ ミトメ,ソノゴ キサンチン ケッショウ ガ シュツゲン シタ 1 ショウレイ

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Abstract

<p>Xanthine crystals that appear during chemotherapy of tumors have been reported to be rare, and they are characterized as being plate-like. We encountered a case in which we suspected the appearance of xanthine crystals, but instead of seeing plate-like crystals, only granular agglomerates were seen, followed by the appearance of typical xanthine crystals. The patient was a female in her 30s. After remission of Ph-negative B-ALL, she underwent nonrelated peripheral blood stem cell transplantation. After hospitalization, chemotherapy was started. Febuxostat was administered to prevent tumor lysis syndrome (TLS) due to the marked disintegration of tumor cells. On day 7 of admission, urine sediment showed granular agglomerates, which were not identified, followed by the appearance of xanthine crystals on day 38, with plate-like and granular morphological characteristics. Both were soluble in potassium hydroxide and insoluble on heating and in hydrochloric acid and normal saline. On day 7 of hospitalization, the urine had a neutral pH of 7.0 and the urine volume was maintained, suggesting that the xanthine crystals were in the process of forming typical platelets. The urinary sediment suggests that crystals may have been involved in renal impairment. Therefore, the detection of xanthine crystals is highly significant, and it is important to understand that xanthine crystals may not show the typical platelet-like shape as in this case.</p>

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