PT  - JOURNAL ARTICLE
AU  - Turab Jawaid Mohammed
AU  - Rohit Gosain
AU  - Rajeev Sharma
AU  - Pallawi Torka
TI  - Lactic acidosis: a unique presentation of diffuse large B-cell lymphoma
AID  - 10.1136/bcr-2019-230277
DP  - 2019 Oct 01
TA  - BMJ Case Reports
PG  - e230277
VI  - 12
IP  - 10
4099  - http://casereports.bmj.com/content/12/10/e230277.short
4100  - http://casereports.bmj.com/content/12/10/e230277.full
SO  - BMJ Case Reports2019 Oct 01; 12
AB  - An elderly man in the seventh decade of life was brought to the hospital with worsening mental status. Blood tests revealed anaemia and thrombocytopenia with elevated lactate dehydrogenase and serum lactate levels. CT scan showed bulky thoracic and abdominal lymphadenopathy with splenomegaly. A positron emission tomography scan confirmed the above and in addition, revealed bilateral adrenal involvement. Bone marrow biopsy revealed non-germinal centre B-cell-like (non-GCB)-diffuse large B-cell lymphoma (DLBCL). Prompt treatment with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab with intrathecal methotrexate chemotherapy resulted in a dramatic improvement in the patient’s condition. This vignette serves as a reminder to include aggressive lymphomas like DLBCL in the differential diagnoses of patients presenting with metabolic encephalopathy and lactic acidosis. Our patient was moribund at presentation with poor sensorium and failure to thrive. The dilemma was whether to take an aggressive stand and start chemotherapy urgently or whether to stabilise the patient first and then consider the treatment of DLBCL. We make a case for initiating therapy promptly in such patients irrespective of their performance status.