Complete Heart Block and Persistent Lactic Acidosis as an Initial Presentation of Non-Hodgkin Lymphoma in a Critically Ill Newly Diagnosed AIDS Patient

Abstract

A 66-year-old male with newly diagnosed untreated acquired immunodeficiency syndrome (AIDS) presented with chronic nonspecific complaints of weakness, fatigue, myalgia, and weight loss. His initial EKG showed complete heart block necessitating temporary pacemaker placement. He had no previous history of cardiac disease. He was also found to have a persistent lactic acidosis and imaging studies showed abdominal lymphadenopathy. The patient underwent biopsy of these lymph nodes and was found to have diffuse large B-cell lymphoma. The hospital course was complicated by respiratory failure requiring mechanical ventilator support and cardiac arrest. Patient remained critically ill; he was not a candidate for chemotherapy and, after a month of hospitalization, he died. Lactic acidosis and heart block as an initial presentation of non-Hodgkin lymphoma in an AIDS patient are an unusual and unique presentation.

Cardiac lymphoma presenting as bradyarrhythmia

“…A similar presentation was reported in a 66-year-old AIDS patient in 2014, who was also found to have diffuse large B-cell lymphoma with cardiac involvement. 10 The patients in most previously reported cases of cardiac lymphoma with lactic acidosis did not survive. 10 Other cases of diffuse large B-cell lymphoma resulting in complete heart block have shown restoration of AV nodal conduction with as little as 3 cycles of R-CHOP.…”

“… 10 The patients in most previously reported cases of cardiac lymphoma with lactic acidosis did not survive. 10 Other cases of diffuse large B-cell lymphoma resulting in complete heart block have shown restoration of AV nodal conduction with as little as 3 cycles of R-CHOP. 7 , 11 , 12 Caramelli and Tellini 13 reported cases of resolution of intermittent complete heart block with prednisone therapy.…”

Severe Type B Lactic Acidosis in a Rare and Aggressive HIV-Related Lymphoma

“…Consumption of glucose for lymphoma cell replication resulting in lactic acidosis is sometimes associated with persistent hypoglycemia. There are numerous case reports of patients requiring aggressive intravenous repletion of glucose along with management of their lactic acidosis [2, 5, 7–9].…”