title: Obscure Severe Infrarenal Aortoiliac Stenosis With Severe Transient Lactic Acidosis.
abstract: A 57-year-old man presented with sudden onset of leg pain, right-sided weakness, aphasia, confusion, drooling, and severe lactic acidosis (15 mmol/L). He had normal peripheral pulses and demonstrated no pain, pallor, poikilothermia, paresthesia, or paralysis. Empiric antibiotics, aspirin, full-dose enoxaparin, and intravenous fluid were initiated. Lactic acid level decreased to 2.5 mmol/L. The patient was subsequently extubated and was alert and oriented with no complaints of leg or abdominal pain. Unexpectedly, the patient developed cardiac arrest, rebound severe lactic acidosis (8.13 mmol/L), and signs of acute limb ischemia. Emergent computed tomography of the aorta confirmed infrarenal aortoiliac thrombosis. Transient leg pain and transient severe lactic acidosis can be unusual presentations of severe infrarenal aortoiliac stenosis. When in doubt, vascular studies should be implemented without delay to identify this catastrophic diagnosis.
authors.affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Teerapat
authors.initials: T
authors.lastname: Nantsupawat
authors.affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Charoen
authors.initials: C
authors.lastname: Mankongpaisarnrung
authors.affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Suthipong
authors.initials: S
authors.lastname: Soontrapa
authors.affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Chok
authors.initials: C
authors.lastname: Limsuwat
authors.affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
keywords: aortoiliac stenosis; infrarenal; lactic acidosis; limb ischemia; transient