Acute liver failure and severe lactic acidosis as initial manifestations of primary intestinal diffuse large B-cell...

Diffuse large B-cell lymphoma (DLBCL) typically presents with lymphadenopathy or extranodal masses, but rarely, predominantly as scattered case reports, as acute liver failure (ALF) with severe lactic acidosis. We report a 79-year-old man who presented with fulminant ALF, leukemoid reaction, and extreme lactic acidosis. Despite intensive care, he rapidly progressed to multiorgan failure and died. Autopsy revealed primary intestinal DLBCL with diffuse hepatic infiltration. This case illustrates the diagnostic challenge in emergency settings and highlights the concept of a "metabolic catastrophe" characterized by ALF, leukemoid reaction, and lactic acidosis. Early recognition of these features should prompt consideration of invasive diagnostic procedures and suspicion for aggressive lymphoma.