Aggressive undifferentiated carcinoma of unknown primary site complicated by lactic acidosis after bleeding: a case report.
Undifferentiated carcinoma of unknown primary site complicated by lactic acidosis has not been documented. We describe a young female with undifferentiated carcinoma of unknown primary site manifested by widespread lymph node and hepatic infiltration, hyperuricemia and very high levels of lactate dehydrogenase. She developed lactic acidosis suddenly after an episode of bleeding following nasal biopsy. The bleeding episode is likely to have caused subclinical hepatic hypoperfusion and hypoxemia, thereby aggravating lactate overproduction by tumor cells and clearance impairment due to diffuse hepatic infiltration to result in rapidly fatal acidosis before cytotoxic agents could be instituted. Although uncommon, when a critical event occurs in aggressive malignancies with massive hepatic involvement, the clinician should be alert for the development of lactic acidosis because the life-threatening metabolic complication is best avoided by prompt and effective cytoreduction therapy.
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. wkchau@vghtpe.gov.tw
Wing Keung
WK
Chau
Ching Fen
CF
Yang
Yi Hong
YH
Chou
Chao Hung
CH
Ho
D000140:Acidosis, Lactic / Q000209:etiology*; D000328:Adult; D002277:Carcinoma / Q000150:complications / Q000556:secondary*; D004844:Epistaxis / Q000150:complications*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009382:Neoplasms, Unknown Primary