[Severe lactic acidosis revealing hematologic malignancy]

Area of Science:

• Oncology
• Hematology
• Critical Care Medicine

Background:

• Sepsis and cholecystitis are common critical care presentations.
• Lactic acidosis is a frequent complication in critically ill patients, often indicating poor prognosis.

Observation:

• A 75-year-old female presented with sepsis, initially treated for cholecystitis.
• Despite antibiotics, cholecystectomy, and hemofiltration, severe lactic acidosis persisted, suggesting an alternative diagnosis.
• Further investigation revealed Epstein-Barr virus (EBV)-induced B-cell lymphoma.

Findings:

• The case highlights a rare presentation of type B lactic acidosis secondary to malignancy.
• B-cell lymphoma, particularly EBV-induced, can manifest with severe metabolic derangements.
• Diagnostic challenges in critically ill patients require consideration of unusual etiologies.

Implications:

• This case underscores the importance of considering malignancy as a cause of refractory lactic acidosis in sepsis.
• Early suspicion and diagnosis of underlying lymphoma are crucial for appropriate management and improved patient outcomes.
• Highlights the complex interplay between infection, critical illness, and hematologic malignancies.