title: Diffuse large B-cell lymphoma: A metabolic disorder?
abstract: Patient Male, 81 FINAL DIAGNOSIS: Non-Hodgkin lymphoma Symptoms: General weakness • hypoglycemia • metabolic acidosis
  
  
  METHODS
  - Clinical Procedure: - Specialty: Hematology.
  
  
  OBJECTIVE
  Challenging differential diagnosis.
  
  
  BACKGROUND
  B cell lymphoma constitutes 80-85% of cases of Non Hodgkin's lymphoma in the Untied States. Metabolic complications may arise from the disease itself or through its end organ involvement.
  
  
  METHODS
  We describe a case of a diffuse large B cell lymphoma diagnosed by abdominal computed tomography after it initially presented as hypoglycemia not correctable by dextrose infusion that instead resulted in increased anion gap metabolic acidosis with elevated lactate levels.
  
  
  CONCLUSIONS
  The case illustrates how lymphomas can present unusually with hypoglycemia and lactic acidosis, the latter being an ominous sign that can occur without liver involvement. In this regard, the case demonstrates the metabolic sequelae of lymphoma that should raise suspicion for an underlying process. This has implications for diagnosis, treatment, and patient survival. Attention should be paid especially in the primary care setting in order to minimize delays in diagnosis.
authors.affiliation: Department of Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN, U.S.A.
authors.forename: Georges
authors.initials: G
authors.lastname: Tanios
authors.affiliation: Department of Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN, U.S.A.
authors.forename: Ines M
authors.initials: IM
authors.lastname: Aranguren
authors.affiliation: Department of Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN, U.S.A. ; Department of Internal Medicine, Mountain Home VA Medical Center, Johnson City, TN, U.S.A.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Goldstein
authors.affiliation: Department of Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, TN, U.S.A.
authors.forename: Chirag B
authors.initials: CB
authors.lastname: Patel
keywords: B-cell lymphoma; Non Hodgkin’s lymphoma; Warburg effect; hypoglycemia; lactic acidosis