Lactic acidosis as the initial manifestation of Acute Lymphoblastic Leukemia A case report.
Main Article Content
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.
Downloads
Article Details
![Creative Commons License](http://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
Khalid K, Padda J, Syam M, Moosa A, Kakani V, Sanka S, Zubair U, Padda S, Cooper AC, Jean-Charles G. 13q14 Deletion and Its Effect on Prognosis of Chronic Lymphocytic Leukemia. Cureus. 2021 Aug 2;13(8):e16839. doi: 10.7759/cureus.16839. PMID: 34522485; PMCID: PMC8424995.
Lozano Rodas Y, Palacios Ordoñez EV, Toralva A. Acidosis láctica y leucemia aguda: presentación de un caso clínico y revisión de la literatura. Rev Soc Peru Med Interna [Internet]. 2019; 28(4):187-92. Disponible en: https://revistamedicinainterna.net/index.php/spmi/article/view/116
Narayani S, Balu P, Santhanam R, Scott JX. Type B Lactic Acidosis: A Rare Initial Presentation of Childhood Acute Lymphoblastic Leukemia. Indian J Nephrol. 2019 Jan-Feb;29(1):71-73. doi: 10.4103/ijn.IJN_181_16. PMID: 30814800; PMCID: PMC6375013.
Kumar A, Raina V. Non-Hodgkins lymphoma with lactic acidosis at presentation: A case report of a rare oncologic emergency. Indian J Med Paediatr Oncol. 2014 Jan;35(1):83-5. doi: 10.4103/0971-5851.133728. PMID: 25006291; PMCID: PMC4080670.
T Brault C, Zerbib Y, Delette C, Marc J, Gruson B, Marolleau JP, Maizel J. The Warburg Effect as a Type B Lactic Acidosis in a Patient With Acute Myeloid Leukemia: A Diagnostic Challenge for Clinicians. Front Oncol. 2018 Jun 20;8:232. doi: 10.3389/fonc.2018.00232. PMID: 29974036; PMCID: PMC6019439.
Natarajan B, Prathap P, Asokan N, Balakrishnan S. Lipoid proteinosis – An erratic disease with an archetypal presentation. J Skin Sex Transm Dis 2020;2(1):56-8. https://jsstd.org/lipoid-proteinosis-an-erratic-disease-with-an-archetypal-presentation/
Hayek M, Srinivasan A. Acute lymphoblastic leukemia presenting with lactic acidosis and renal tubular dysfunction. J Pediatr Hematol Oncol. 2003 Jun;25(6):488-90. doi: 10.1097/00043426-200306000-00012. PMID: 12794529.
Sillos EM, Shenep JL, Burghen GA, Pui CH, Behm FG, Sandlund JT. Lactic acidosis: a metabolic complication of hematologic malignancies: case report and review of the literature. Cancer. 2001 Nov 1;92(9):2237-46. doi: 10.1002/1097-0142(20011101)92:9<2237::aid-cncr1569>3.0.co;2-9. PMID: 11745277.
Aranibar L, Ramírez C, Arellano J, Wortsman X, Sazunic I. Pentoxifilina como tratamiento efectivo de la lipoidoproteinosis. Dermatol. Pediátr. Latinoam, 2014; 12(1): 31-34. https://pesquisa.bvsalud.org/portal/resource/pt/lil-776143?lang=es
Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013 Oct;88(10):1127-40. doi: 10.1016/j.mayocp.2013.06.012. PMID: 24079682; PMCID: PMC3975915.