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17 April 2018 : Case report  Saudi Arabia

Acute Lymphoblastic Leukemia Presenting with Liver Infiltration and Severe Lactic Acidosis

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Ayman Hassan Sayyed1ABDEF, Aamer Aleem1ABDEF*, Mohammad Sami Al-Katari1ABE, Fatma Algahtani2ABDE, Khaldoon Aljerian3BDE, Talha A. Aleem4DEF, Khalid Alsaleh1ABDE

DOI: 10.12659/AJCR.907383

Am J Case Rep 2018; 19:453-457

Abstract

BACKGROUND: Type-B lactic acidosis is a rare complication of solid tumors and hematological malignancies. It occurs secondary to Warburg effect, when glucose metabolism in cancer cells switches from the oxidative pathway to the glycolytic pathway. Malignant lactic acidosis is a life-threatening condition if not promptly diagnosed and treated urgently.

CASE REPORT: We report the case of a 58-year-old male patient who presented with severe chest pain, dyspnea, systemic symptoms, leukopenia, normocytic anemia, and severe lactic acidosis. He was admitted with a possible diagnosis of acute pericarditis and lactic acidosis. Sodium bicarbonate replacement did not improve the lactic acidosis. Liver biopsy was performed because of persistently elevated alkaline phosphatase and gamma-glutamyl transferase; the biopsy showed atypical lymphoblasts and bone marrow biopsy confirmed the diagnosis of precursor B acute lymphoblastic leukemia. Lactic acidosis normalized after initiation of chemotherapy.

CONCLUSIONS: Cancer, particularly hematological malignancy, should be considered as an etiology and differential diagnosis of type-B lactic acidosis. Prompt recognition and urgent initiation of specific therapy to control the underlying malignancy are critical to manage this serious metabolic complication.

Keywords: Acidosis, Lactic, Precursor B Cell Lymphoblastic Leukemia, Hepatic Infiltration

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923