SHM Converge Scientific Abstract ePoster Gallery-From Infection to Oncology: A Diagnostic Plot Twist

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This case highlights a diagnostic “plot twist” in a 58-year-old man initially treated for babesiosis. He had fatigue, dyspnea, and pancytopenia after a recent Babesia microti infection, so clinicians first suspected ongoing hemolysis or bone marrow suppression from infection. Although his Babesia PCR remained positive, repeated peripheral smears showed no parasites, and his symptoms improved after transfusion.<br /><br />The key abnormality was persistent lactic acidosis: bicarbonate was low and lactate rose to 9–12 mmol/L, yet his blood pH was normal and he showed no evidence of shock, hypoxemia, sepsis, or organ failure. Despite fluids, the lactate stayed elevated. A broad workup, including evaluation for D-lactate, methemoglobinemia, inflammation, nutritional deficiencies, muscle injury, and CT imaging, was unrevealing.<br /><br />Because pancytopenia persisted, a bone marrow biopsy was performed and revealed B-cell acute lymphoblastic leukemia (ALL) with 75% blasts. Next-generation sequencing also found an IDH1 mutation. The elevated lactate was therefore attributed to the Warburg effect, a form of type B lactic acidosis seen in malignancy, where cancer cells rely on aerobic glycolysis even when oxygen is available. This metabolic shift supports rapid tumor growth but can produce severe lactic acidosis.<br /><br />After starting Hyper-CVAD chemotherapy, the patient’s metabolic acidosis resolved within 36 hours and lactate normalized significantly on follow-up. He also received extended babesiosis treatment because of immunosuppression from chemotherapy, and repeat Babesia PCR became negative.<br /><br />The case emphasizes that persistent lactic acidosis without hypoperfusion or hypoxemia should prompt consideration of an underlying malignancy, especially hematologic cancer. Early recognition of the Warburg effect is critical because it represents an oncologic emergency requiring treatment of both the acidosis and the cancer itself.

Asset Subtitle

Zhenyang Jiang

Meta Tag

Author List Zhenyang Jiang

Category Clinical Vignettes

Concept Lactic Acidosis

Concept Warburg Effect

Concept Type A Lactic Acidosis

Concept Type B Lactic Acidosis

Concept Malignancy

Distinguished Non-Finalist

Presenter Organization UMass Memorial Medical Center

Presenting Author Zhenyang Jiang

Track Adult

Keywords

babesiosis

lactic acidosis

Warburg effect

B-cell acute lymphoblastic leukemia

pancytopenia

IDH1 mutation

Hyper-CVAD chemotherapy

type B lactic acidosis

bone marrow biopsy

Babesia microti

Lactic Acidosis

Warburg Effect

Type A Lactic Acidosis

Type B Lactic Acidosis

Malignancy