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Case Reports
. 2018 Feb 1;19(2):101-104.
doi: 10.1080/15384047.2017.1394550. Epub 2018 Jan 2.

Type B lactic acidosis, an uncommon paraneoplastic syndrome

Ahsan Wahab  1 , Kavitha Kesari  1 , Susan J Smith  1 , Yang Liu  2 , Stefan K Barta  2
Affiliations
Case Reports

Type B lactic acidosis, an uncommon paraneoplastic syndrome

Ahsan Wahab et al. Cancer Biol Ther. .

Abstract

A 67-year-old male presented with anasarca and persistent non-pruritic rash of lower extremities. Physical examination was positive for subcutaneous edema with a non-blanching rash of abdomen and lower extremities. Labs showed leukocytosis, lymphocytosis, anemia and thrombocytopenia. He also had acute kidney injury and high anion gap (AG) metabolic acidosis with elevated lactic acid (11.3 mg/dL). Computerized tomography (CT) of abdomen and pelvis showed hepatosplenomegaly, ascites and abdominal lymphadenopathy. Peripheral blood (PB) smear showed blastiod appearing lymphocytes. He was started on bicarbonate infusion due to persistent lactic acidosis (LA), however showed no significant improvement. He was started on IV dexamethasone on 3rd day of hospitalization based on preliminary result of peripheral picture which led to some improvement in LA. Following the confirmation of mantle cell lymphoma (MCL) on bone marrow (BM) biopsy and immunophenotyping, the patient started receiving VR-CAP regimen (bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone) which led to significant improvement in LA and leukocytosis. After discharge, he received further chemotherapy with resolution of the LA and normalization of blood counts. Restaging tests confirmed a complete remission with resolution of the skin rash, resolution of the pathological lymphadenopathy and hepatosplenomegaly on imaging, and absence of lymphoma on a repeat BM biopsy.

Keywords: Bone Marrow Biopsy; Chemotherapy; Immunophenotyping; Lactic acid; Lactic acidosis; Leukocytosis; Mantle Cell Lymphoma.

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Figures

Figure 1.
Figure 1.
Showing the temporal Trends of (A) Bicarbonate and AG, (B) WBC count, Lymphocyte count, and (C) Lactic acid Levels over the course of hospital Stay. Figure A: temporal trend of Bicarbonate and AG. On Day 1, Bicarbonate Infusion was Started, and on Day 7, Chemotherapy was Started. Figure B: A Downward Trend of Leukocytosis and Lymphocytosis with IV Dexamethasone (Day 3) and VR-CAP (Day 7). Figure C: Declining Trend of Lactic Acid after IV Dexamethasone, Sodium Bicarbonate and Chemotherapy (VR-CAP).
See this image and copyright information in PMC

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