Une acidose lactique sévère révélatrice d’une hémopathie maligne

Ouchikhe, A.; Bivic, J.-L. Le; Longuet, O.; Maindivide, J.; Vincent, J.-F.

doi:10.1016/j.annfar.2014.05.005

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Here, we present the rare case of a patient who developed a type B LA presumably due to concurrent chronic myelomonocytic leukaemia (CMML). No case to date has identified this association without the context of sepsis or transformation to acute myeloid leukaemia (AML) [ 6 , 9 ]. Clinical uncertainty arose over the cause of the LA due to the paucity of literature on this association.…”

Section: Introductionmentioning

confidence: 99%

A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature

Gardner

Griffiths

2015

J Med Case Reports

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IntroductionType B lactic acidosis represents a rare and often lethal complication of haematological malignancy. Here, we present a patient who developed a type B lactic acidosis presumably due to a concurrent chronic myelomonocytic leukaemia. Upon swift initiation of cytoreductive chemotherapy (doxorubicin), the lactic acidosis was rapidly brought under control. This case adds to the literature reporting other haematological malignancies that can cause a type B lactic acidosis and its successful treatment.Case presentationWe report the case of a 77-year-old Caucasian man brought to our Accident and Emergency department following an unwitnessed collapse; he was found surrounded by coffee-ground vomit. Although haemodynamically stable on admission, he rapidly deteriorated as his lactic acid rose. An initial arterial blood gas revealed a pH of 7.27 and lactate of 18mmol/L (peaking at 21mmol/L).ConclusionsA high degree of clinical suspicion for haematological malignancy should be held when presented with a patient with lactic acidosis in clinical practice, even without evidence of poor oxygenation or another cause. Treatment with emergency chemotherapy, in lieu of a definitive diagnosis, was rapidly successful at lowering lactate levels within 8 hours. This may suggest a causal and perhaps direct relationship between lactic acid production and the presence of leukemic cells. Veno-venous haemofiltration had no apparent effect on reducing the lactic acidosis and therefore its benefit is questioned in this setting, especially at the cost of delaying chemotherapy. In the face of a life-threatening lactic acidosis, pragmatic clinical judgement alone may justify the rapid initiation of chemotherapy.

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Section: Introductionmentioning

confidence: 99%

A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature

Gardner

Griffiths

2015

J Med Case Reports

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“…A literature review found only five patients with AML associated with type B LA ( 5 , 18 – 21 ). Among them, lactate clearance impairment was suspected in three patients because of a history of liver cirrhosis ( 5 ), and a possible liver infiltration by leukemia cells as well as severe renal failure were also found ( 18 , 19 ). Thiamine deficiency was proved in one patient ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

The Warburg Effect as a Type B Lactic Acidosis in a Patient With Acute Myeloid Leukemia: A Diagnostic Challenge for Clinicians

Brault¹,

Zerbib²,

Delette³

et al. 2018

Front. Oncol.

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IntroductionThe Warburg effect (WE) is an uncommon cause of type B lactic acidosis (LA) due to a deregulation of carbohydrate metabolism in neoplastic cells where lactic fermentation predominates over oxidative phosphorylation regardless of the oxygen level.Case presentationWe report the case of a 57-year-old man presenting with concomitant acute myeloid leukemia and type B LA with asymptomatic hypoglycemia. We did not find arguments for a septic state, liver dysfunction, or acute mesenteric ischemia. The WE was suspected, and chemotherapy was immediately undertaken. We observed a rapid and sustained decrease in lactate level and normalization of blood glucose. Unfortunately, we noted a relapse of acute leukemia associated with WE soon after treatment initiation and the patient died in the Intensive Care unit.DiscussionSome patients may present complications directly related to an underlying hematological malignancy. The WE is one of these complications and should be suspected in patients with both hypoglycemia and LA. We propose a checklist in order to help clinicians manage this life-threatening complication. Before considering WE, clinicians should eliminate diagnoses such as septic shock or mesenteric ischemia, which require urgent and specific management.ConclusionThe diagnosis of WE can be challenging for clinicians in the Hematology department and the Intensive Care unit. Prompt diagnosis and rapid, adapted chemotherapy initiation may benefit patient survival.

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Hémopathies sévères révélées aux urgences adultes : étude monocentrique de 108 patients

Dang¹,

Signol²,

Bennett-Petitjean³

et al. 2015

Ann. Fr. Med. Urgence

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Une acidose lactique sévère révélatrice d’une hémopathie maligne

Cited by 4 publications

References 7 publications

A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature

A case of type B lactic acidosis as a complication of chronic myelomonocytic leukaemia: a case report and review of the literature

The Warburg Effect as a Type B Lactic Acidosis in a Patient With Acute Myeloid Leukemia: A Diagnostic Challenge for Clinicians

Hémopathies sévères révélées aux urgences adultes : étude monocentrique de 108 patients

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