Lactic acidosis as the initial manifestation of Acute Lymphoblastic Leukemia A case report.

Abstract

Introduction: Lactic acidosis is a rare manifestation of Acute Lymphoblastic Leukemia (ALL) in children; its pathogenesis is multifactorial and poorly understood. This association carries a fatal prognosis. Timely diagnosis and initiation of proper treatment for hematological neoplasia are the most critical factors in resolving this metabolic complication.

Clinical case: The case of a 5-year-old patient who was admitted to the emergency service with a month of generalized pallor, hyporexia, and ecchymosis is presented; 24 hours before, she had respiratory distress and acidotic respiration. On physical examination, cervical and inguinal adenopathies were found.

Diagnostic workshop: biometry was performed with white blood cells of 9.10 x 10/ul, neutrophils 41.6%, lymphocytes 44.6%, DHL 494 u/L, total bilirubin 0.33 mg/dl, potassium 2.55 mEq/L, Sodium 134 mEq/ L, calcium 11.8 mg/dl, TGP 16 U/L, Ac uric 4.7 mg/dl, Urea 33 mg/dl, Creatinine 0.99 mg/dl, ph 7.15, pCO2 18 mmHg, pO2 58.6 mmHg, HCO3 6.2 mmol/L, Base excess -20.4 mmol/L, Lactate 10 mmol/L. Normal kidney ultrasound. Bone marrow biopsy: pre-B stage acute lymphoblastic leukemia.

Evolution: Type B metabolic acidosis was treated with hydration and intravenous bicarbonate. She was referred for specific hemato-oncological treatment.

Conclusions: In the present case, the persistent metabolic acidosis, without evidence of tissue hypoperfusion, the differential diagnosis of hematological malignancies was considered.