Steroid-induced Lactic Acidosis in Diffuse Large B-cell Lymphoma

Area of Science:

• Nephrology
• Oncology
• Pulmonology

Background:

• Primary membranous nephropathy is an autoimmune kidney disease often associated with antibodies against phospholipase A2 receptor.
• Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma that can present with diverse clinical manifestations.

Observation:

• A 53-year-old male with known membranous nephropathy presented with acute respiratory distress and hypotension.
• The patient rapidly deteriorated, requiring mechanical ventilation, indicating severe systemic compromise.

Findings:

• Further investigations revealed the patient met criteria for tumor lysis syndrome.
• The underlying cause was identified as an undiagnosed diffuse large B-cell lymphoma undergoing rapid cytolysis following initiation of stress-dose steroids.

Implications:

• This case highlights the potential for paraneoplastic syndromes in patients with membranous nephropathy.
• It underscores the importance of considering hematologic malignancies in patients with unexplained rapid deterioration and tumor lysis syndrome.
• Early recognition and management of both the lymphoma and tumor lysis syndrome are critical for patient outcomes.