Type B lactic acidosis associated with diffuse large B-cell lymphoma and the Warburg effect

Abstract

Type B lactic acidosis is a rare complication of non-tissue perfusion abnormalities caused by solid tumors or hematologic malignancies. Herein, we present the case of a 42-year-old man with type B lactic acidosis and hypoglycemia who was found to have a diffuse large B-cell lymphoma. The cause of lactic acidosis and/or hypoglycemia is thought to be the Warburg effect, which is when the metabolic rate of a rapidly growing malignant tumor is very high and dominated by glycolysis. Systemic damage from type B lactic acidosis can occur when the increased rate of glycolysis exceeds the normal muscle and liver lactic acid clearance rate. The Warburg effect is a rare but serious condition that needs to be recognized, not only in diffuse large B-cell lymphoma, but also in other malignancies. The prognosis of lactic acidosis in patients with malignant tumors is very poor. Currently, effective chemotherapy seems to be the only hope for survival.

Association of globulin concentrations with prognosis in horses with lymphoma

“…Unfortunately, plasma lactate was not consistently measured in these horses. Hyperlactatemia is a common cause of increased anion gap in horses and has been documented in human and canine lymphomas ( 28 , 29 ). Malignancy-induced lactic acidosis is suspected to be associated with the high metabolic rate of rapidly growing tumors and cancer metabolic reprogramming, resulting in hypoxia and increased glycolysis and thus lactate production by cancer cells, potentially exceeding the normal clearance rate of muscle and liver lactic acid ( 29 ).…”

Atypical Presentation of Burkitt Lymphoma With Isolated Peritoneal Involvement and Association With Refractory Type B Lactic Acidosis and Hypoglycemia Secondary to the Warburg Effect

“…The mortality rate from lactic acidosis secondary to malignancy is very high. Previously reported data showed that >70% of cases with lymphoma-associated Warburg effect died within 30 days [ 4 , 13 , 14 ].…”

“…Among many others, malignancy is a known rare cause of type B lactic acidosis [ 2 ]. Moreover, the Warburg effect is an uncommon but serious condition that happens when neoplastic cells shift to aerobic glycolysis and it is highly linked to many cancers, particularly B-cell lymphomas [ 3 , 4 ]. It is considered an oncological emergency and is associated with poor prognosis and a high mortality rate if untreated [ 4 ].…”

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

“…Lactic acidosis is the most common anion gap metabolic acidosis in critically ill patients [ 1 ]. It occurs when the production of lactic acid exceeds clearance [ 2 ]. Most of the lactate (80-90%) is cleared by the liver through gluconeogenesis while the remaining is cleared by the kidneys [ 3 , 4 ].…”

“…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 [ 2 ].…”