Lactic acidosis: a unique presentation of diffuse large B-cell lymphoma

Area of Science:

• Hematology
• Oncology

Background:

• Metabolic encephalopathy and lactic acidosis can present with diverse etiologies.
• Aggressive lymphomas, such as diffuse large B-cell lymphoma (DLBCL), should be considered in the differential diagnosis of unexplained metabolic derangements.

Observation:

• An elderly male presented with altered mental status, anemia, thrombocytopenia, elevated lactate dehydrogenase, and lactic acidosis.
• Imaging revealed significant lymphadenopathy, splenomegaly, and bilateral adrenal involvement.
• Bone marrow biopsy confirmed non-germinal center B-cell-like (non-GCB) DLBCL.

Findings:

• The patient's condition dramatically improved following prompt chemotherapy with a dose-adjusted regimen including etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, rituximab, and intrathecal methotrexate.
• This case underscores the importance of early diagnosis and aggressive treatment for DLBCL, even in critically ill patients.

Implications:

• Aggressive lymphomas like DLBCL can manifest with unusual symptoms, necessitating a broad differential diagnosis.
• Urgent chemotherapy initiation is crucial for improving outcomes in patients with DLBCL presenting with severe systemic illness, irrespective of initial performance status.