B-cell hepatosplenic lymphoma presenting in adult patient after spontaneous splenic rupture followed by severe persistent hypoglycaemia: type B lactic acidosis and acute liver failure

Abstract

A patient was admitted to hospital with splenic rupture, four 4 days after colonoscopy was performed following one month’s intermittent and aggravating abdominal pain. During recovery from splenectomy, the patient developed sudden tachycardic and tachypnoea. A blood sample revealed a very low blood glucose, high lactate and acidaemia.The patient required high-dose continuous intravenous glucose, while the lactate remained elevated. Decreasing consciousness with signs of acute liver failure necessitated transfer to an advanced intensive care unit. The patient’s clinical status rapidly deteriorated despite therapeutic intervention. The patient died of multiorgan failure eleven days post-splenectomy. Based on the pathology of the spleen and a post-mortem liver specimen, the patient was diagnosed with a primary extra-nodal B-cell hepatosplenic lymphoma (BCHSL) – an extremely rare form of non-Hodgkin lymphomanon.Splenic rupture followed by lactic acidosis and hypoglycaemia should lead to suspicion of a cancer-mediated Warburg effect, and prompt urgent chemotherapy.

B-Cell Lymphoma With Prominent Presentation of Lactic Acidosis: A Case Report and Brief Review of the Literature

“…Physiologically, lactic acidosis can be categorized into two types: Type A, stemming from tissue hypoxia and hypoperfusion; and Type B, typically lacking evident tissue hypoxia and associated with factors such as innate abnormalities, toxic substances, or other cellular metabolism disorders [4]. Type B lactic acidosis is recognized as a hematologic emergency, and it is linked with hematologic malignancies in approximately 85% of cases [5]. Notably, lymphoma, multiple myeloma, and leukemia are the most common contributors, with a staggering mortality rate exceeding 90% [6,7].…”

Atraumatic splenic rupture

“…Det skal dog bemaerkes, at der er tale et ganske lille antal (syv cases) [3]. [18]. Dertil kommer behandling af den underliggende sygdom.…”