Lymphoma and Lactic Acidosis

A 39-year-old man presented with new onset of sinus congestion, shortness of breath, and diaphoresis. His laboratory tests were notable for hypercalcemia and lactic acidosis. A CT scan of the head demonstrated mild paranasal disease. CT scan of the chest, abdomen, and pelvis demonstrated omental caking with lymphadenopathy and a thickened loop of bowel in the left upper quadrant suggestive of lymphoma. All abdominal lesions seen in the CT were intensely F-FDG avid with diffuse uptake in the bone marrow. There was markedly decreased F-FDG uptake in both the brain and liver. Histopathology was positive for Burkitt lymphoma.