Lactic acidosis: a unique presentation of diffuse large B-cell lymphoma. Issue 10 (25th October 2019)

• Record Type: Journal Article
• Authors: Mohammed, Turab Jawaid; Gosain, Rohit; Sharma, Rajeev; Torka, Pallawi
• Is Part Of: BMJ case reports. Volume 12:Issue 10(2019)
• Publication Date: 2019-10-25
• Subjects: cancer intervention -- metabolic disorders -- haematology (incl blood transfusion) -- nosocomial infections -- coma and raised intracranial pressure; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-230277
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : An elderly man in the seventh decade of life was brought to the hospital with worsening mental status. Blood tests revealed anaemia and thrombocytopenia with elevated lactate dehydrogenase and serum lactate levels. CT scan showed bulky thoracic and abdominal lymphadenopathy with splenomegaly. A positron emission tomography scan confirmed the above and in addition, revealed bilateral adrenal involvement. Bone marrow biopsy revealed non-germinal centre B-cell-like (non-GCB)-diffuse large B-cell lymphoma (DLBCL). Prompt treatment with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab with intrathecal methotrexate chemotherapy resulted in a dramatic improvement in the patient's condition. This vignette serves as a reminder to include aggressive lymphomas like DLBCL in the differential diagnoses of patients presenting with metabolic encephalopathy and lactic acidosis. Our patient was moribund at presentation with poor sensorium and failure to thrive. The dilemma was whether to take an aggressive stand and start chemotherapy urgently or whether to stabilise the patient first and then consider the treatment of DLBCL. We make a case for initiating therapy promptly in such patients irrespective of their performance status.