Critical care issues in management of high-grade lymphoma

Lymphoma presents itself from slow growing and asymptomatic to aggressive and destructive. Suspicion of aggressive lymphoma warrants prompt diagnostic evaluation because the tumor can be extremely fast growing and can cause significant sequelae including but not limited to tissue damage, immune suppression, organ failure, compromised circulation, and death. The standard evaluation includes laboratory assay, infectious disease panel, radiographic imaging with computed tomography, bone marrow biopsy, and tissue diagnosis. Two cases studies are presented describing the range of different acute issues that may arise with aggressive lymphomas including tumor lysis, HIV, small bowel obstruction, superior vena cava compression, aggressive disease transformation, and acute renal injury.