An Oncological Emergency: Severe Type B Lactic Acidosis From Warburg Effect in Diffuse Large B-cell Lymphoma

Abstract

Lactic acidosis is the most common anion gap metabolic acidosis in critically ill patients. Type B lactic acidosis is most commonly seen with hematological malignancies, especially lymphomas. It is considered an oncological emergency and is associated with high mortality and poor outcomes if not treated promptly. Here, we present the case of a 48-year-old male who developed Type B lactic acidosis secondary to newly diagnosed diffuse large B-cell lymphoma. This case highlights the importance of including Type B lactic acidosis in the differential diagnosis in a patient with unexplained lactic acidosis and hypoglycemia with otherwise vague symptoms and the need for a thorough search for quick diagnosis and early management.

The Aurora kinase inhibitor AT9283 inhibits Burkitt lymphoma growth by regulating Warburg effect

“…The reprogramming of glucose metabolism leading to an augmented aerobic glycolysis, commonly known as the Warburg effect, is recognized as a distinctive feature of tumor cells ( Fukushi et al, 2022 ), and plays a crucial role in tumor progression. Lactic acidosis has been reported as the most common types of acidosis in many malignant tumors, including hematological malignancies, especially lymphomas ( Looyens et al, 2021 ; Sanivarapu et al, 2022 ). To ascertain the involvement of glycolysis in the progression of B-cell lymphoma, we conducted a comparative analysis of the mRNA expression levels of Aurora A and Warburg effect-related genes in B-cell lymphoma and normal tissues using the GEPIA online database.…”

Unveiling of Type B Lactic Acidosis From Systemic Lupus Erythematosus-Associated B-cell Lymphoma: A Fatal Oncology Emergency

“…Mortality has a linear relationship to the duration of lactic acidosis as well as its levels. Type B lactic acidosis was found to be associated with a poor prognosis irrespective of aggressive management, with a reported mortality rate of >90% [ 7 , 8 ].…”

“…Our patient was treated appropriately with these supportive measures, and though there was suspicion of underlying cancer causing lactic acidosis, more readily correctable causes were treated first as per the algorithm. Cytoreductive chemotherapy is the treatment modality for lactic acidosis caused by underlying malignancy, as it is caused by the high tumor burden [ 8 ]. Even with cytoreduction, remission is reported only in 10% of patients, and the prognosis remains poor [ 10 ].…”

B-cell hepatosplenic lymphoma presenting in adult patient after spontaneous splenic rupture followed by severe persistent hypoglycaemia: type B lactic acidosis and acute liver failure

“…Based on published case reports, patients with lymphoma who showed evidence of the Warburg effect, all died when not treated with chemotherapy (table 1). Of 30 cases published from 1964 to 2023, only five patients4 41–44 had a positive outcome, all being treated with chemotherapy.…”