Type B Lactic Acidosis, an Unusual but Important Marker for Diagnosis of Hematologic Malignancy

ABSTRACT

Introduction:

Lactic Acid is a byproduct of the normal physiologic processes present in the human body. However, elevated lactic acid in the body, or lactic acidosis, can be a key finding in diseased states as well. Malignancies, especially hematological, are a rare but important cause of lactic acidosis without systemic hypoperfusion, with resolution being directly related to the treatment of the culprit malignancy.

Case:

A 50-year-old male presented to the ED and was diagnosed with acute pancreatitis based on symptoms, lipase levels, and imaging findings. He was found to have leukocytosis and anion gap metabolic acidosis with elevated lactic acid and beta-hydroxybutyrate. He was treated with IV fluids with resolution of all metabolic parameters except lactic acidosis and new pancytopenia. A bone marrow biopsy was performed outpatient due to persistent pancytopenia and lactic acidosis and found to be consistent with B-Cell Acute Lymphoblastic Leukemia. Initiation of chemotherapy normalized lactic acid levels within 5 days.

Discussion:

Lactic Acidosis is a common marker of systemic hypoperfusion, but it can rarely occur in the absence of it, especially in malignancies. One mechanism for this is the “Warburg phenomenon” and another could be Riboflavin/Thiamine deficiency. Patients may have potentially long-standing lactic acidosis, and it may be the initial presentation of malignancy, like in our patient. Treatment of underlying cancer resolves this Type B lactic acidosis.

Conclusion:

Lactic Acidosis in an otherwise vitally stable patient with deranged cell counts should raise concern for Type B Lactic acidosis due to possible hematologic malignancy.

No relevant conflicts of interest to declare.