Burkitt's lymphoma presenting with lactic acidosis and hypoglycemia - a case presentation

We present what appears to be the first reported case of lactic acidosis and hypoglycemia in an adult patient with Burkitt's lymphoma. Lactic acidosis and hypoglycemia are rare complications of non-Hodgkin's lymphoma (NHL) with only 26 and 8 previous reports, respectively. Two prior cases of Burkitt's lymphoma-induced lactic acidosis have been reported (one child, one adult), both in the absence of hypoglycemia. A 74-year-old man presented with right upper extremity swelling, pleural effusion and axillary lymphadenopathy. Thoracentesis and bone marrow studies revealed Burkitt's lymphoma. On the second day of his hospitalization he developed severe lactic acidosis (pH 7.29, lactate 15.8 mmol/L) and hypoglycemia (27 - 60 mg/dl) resistant to glucose infusions. Serum insulin, proinsulin and C-peptide levels were normal and insulin antibodies were negative. Insulin-like growth factors I and II were low, while thyroid and cortisol studies were normal. The patient's mental status became altered, care was withdrawn and the patient expired. An autopsy revealed significant tumor burden that appeared to spare the liver. An extensive review of the literature demonstrates that NHL-induced lactic acidosis is associated with a mortality rate of 73% at 1 month and 92% overall with the clinical course closely linked to the chemotherapeutic response of the tumor. Furthermore, in contrast to our patient, 90% of previously reported cases were associated with liver involvement.