Lactic Acidosis and Hypoglycemia in a Patient with Gastric Diffuse Large B-Cell Lymphoma due to the Warburg Effect

Abstract

Lactic acidosis is pathophysiologically classified into type A and type B. The latter is a rare but potentially life-threatening emergency, mainly described in hematological malignancies. The association between Type B lactic acidosis and malignancy is known as the Warburg effect. Patients with the Warburg effect have a very poor prognosis. Herein, we report a case of gastric diffuse large B-cell lymphoma (DLBCL) with severe lactic acidosis and hypoglycemia owing to the Warburg effect that were effectively treated by prompt introduction of chemotherapy. A 73-year-old woman with a 2-month history of abdominal distension was referred to us for suspected peritoneal cancer. Pathological examination revealed gastric DLBCL with peritoneal dissemination. After hospitalization, blood test results revealed prolonged hypoglycemia, with a blood sugar level of 50-70 mg/dL; severe lactic acidosis with pH 7.166; lactate level 12.7 mmol/L; and base excess −21.0 mEq/L, despite continuous administration of glucose and sodium bicarbonate. The cause of lactic acidosis and/or hypoglycemia was considered to be the Warburg effect. We initiated a 50% reduced-dose CHOP (cyclophosphamide, vincristine, doxorubicin, prednisolone) chemotherapy regimen without rituximab until information on the CD20-positive status was available. During chemotherapy, acidosis, hypoglycemia, and impaired consciousness promptly improved. If lactic acidosis or hypoglycemia is present in patients with malignant tumors, it is important to suspect the possibility of the Warburg effect and to introduce cancer treatment as soon as possible.

Clinical Warburg Effect in a Patient With Mantle Cell Lymphoma: A Case Report

“…Previous case reports have underscored the importance of early treatment involving chemotherapy, glucose, and bicarbonate in addressing CWE [ 11 , 12 ]. The patient was promptly initiated on chemotherapy with rituximab and acalabrutinib after she presented with CWE, despite the initial plan to begin treatment after her renal failure and anemia due to blood loss from her renal biopsy improved.…”

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.…”

Emergent Hemodialysis Followed by Continuous Renal Replacement Therapy: A Management Challenge in a Patient With Life-Threatening Metabolic Acidosis of Multifactorial Etiology

“…Lactic acidosis can be categorized as type A if there is evidence of tissue hypoperfusion from shock, or as type B in the absence of tissue hypoperfusion that might include toxin-induced impairment of the metabolism at ischemic foci [ 4 ]. In diabetic patients, intentional or accidental overdose of metformin can cause lactic acidosis.…”