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Diffuse large B-cell lymphoma: A metabolic disorder?

Georges Tanios1, Ines M Aranguren1, Jack S Goldstein2

  • 1Department of Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN, U.S.A.

The American Journal of Case Reports
|December 19, 2013
PubMed
Summary

This case highlights how Non-Hodgkin lymphoma can unusually present with hypoglycemia and lactic acidosis. Early recognition of these metabolic complications is crucial for timely diagnosis and improved patient outcomes.

Keywords:
B-cell lymphomaNon Hodgkin’s lymphomaWarburg effecthypoglycemialactic acidosis

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Area of Science:

  • Hematology
  • Oncology
  • Internal Medicine

Background:

  • Non-Hodgkin lymphoma (NHL), particularly B cell lymphoma, is a common malignancy in the United States.
  • Metabolic complications can arise directly from lymphoma or its impact on end organs.
  • Unusual presentations of lymphoma can delay diagnosis and treatment.

Purpose of the Study:

  • To present a case of diffuse large B cell lymphoma with unusual metabolic presentations.
  • To emphasize the importance of considering lymphoma in patients with unexplained hypoglycemia and metabolic acidosis.
  • To highlight the diagnostic challenges and implications for patient management.

Main Methods:

  • Case report of an 81-year-old male presenting with general weakness, hypoglycemia, and metabolic acidosis.
  • Diagnostic workup included abdominal computed tomography (CT).
  • Clinical procedure involved hematology consultation and management of metabolic derangements.

Main Results:

  • The patient was diagnosed with diffuse large B cell lymphoma.
  • Initial presentation included hypoglycemia unresponsive to dextrose infusion, leading to increased anion gap metabolic acidosis with elevated lactate.
  • Abdominal CT was crucial in identifying the lymphoma.

Conclusions:

  • Lymphoma can present with metabolic sequelae such as hypoglycemia and lactic acidosis, even without liver involvement.
  • Lactic acidosis in this context is an ominous sign requiring thorough investigation for underlying malignancy.
  • Increased awareness in primary care settings is essential to minimize diagnostic delays for lymphoma.