SHM Converge Scientific Abstract ePoster Gallery-A Fermenting Diagnosis: Lymphoma Presenting as the Warburg Effect

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This case describes a 65-year-old man who presented with severe lactic acidosis (lactate 10.3 mmol/L) without signs of shock or hypoperfusion, suggesting type B lactic acidosis. He also had constitutional symptoms, including drenching night sweats and weight loss, along with chronic sinus pain, epistaxis, tinnitus, dizziness, and decreased hearing.<br /><br />Initial workup showed an anion gap metabolic acidosis, anemia, thrombocytopenia, and rare blasts on blood smear. Peripheral flow cytometry was largely unrevealing, and CT imaging showed multifocal splenic infarcts. Despite IV fluids, antibiotics, and thiamine, his lactate worsened, peaking at 16 mmol/L.<br /><br />Further evaluation found a polypoid mass in the left nasal cavity. MRI demonstrated an extensive invasive mass with intracranial and multicompartmental spread. Pathology confirmed extranodal NK/T-cell lymphoma. After urgent chemotherapy was started, his lactate normalized within four days.<br /><br />The report emphasizes that type B lactic acidosis can occur without systemic hypoperfusion and has a broad differential, including alcohol use, diabetes/DKA, medications such as metformin, liver or kidney disease, thiamine deficiency, HIV, mitochondrial defects, and malignancy. In cancer, the cause may be the Warburg effect, in which tumor cells preferentially use aerobic glycolysis, producing excess lactate even when oxygen is available.<br /><br />Key teaching points are that unexplained lactic acidosis should prompt concern for occult hematologic malignancy, and that rapid diagnosis is critical because chemotherapy is the definitive treatment. Temporizing measures such as bicarbonate or hemodialysis may help briefly, but they do not address the underlying cancer. The case highlights the high mortality associated with malignancy-related lactic acidosis and the importance of early recognition.

Asset Subtitle

Rachel Chang

Meta Tag

Author List Andrew R. Lai, Gregory Ow, Rachel Chang

Category Clinical Vignettes

Concept Type B Lactic Acidosis

Concept Warburg Effect

Concept Type A Lactic Acidosis

Concept Hematologic Malignancy

Concept Cancer-Related Lactic Acidosis

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Rachel Chang

Track Adult

Keywords

type B lactic acidosis

extranodal NK/T-cell lymphoma

Warburg effect

occult hematologic malignancy

anion gap metabolic acidosis

splenic infarcts

nasal cavity mass

intracranial spread

chemotherapy

night sweats

Type B Lactic Acidosis

Warburg Effect

Type A Lactic Acidosis

Hematologic Malignancy

Cancer-Related Lactic Acidosis