CHEST Guidelines-A-66-Year-Old-Woman-With-Sudden-Onset-of-Dissemina

A-66-Year-Old-Woman-With-Sudden-Onset-of-Dissemina

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A 66-year-old woman presented with symptoms including malaise, nausea, night sweats, and dyspnea. Her initial evaluation revealed disseminated intravascular coagulation (DIC), characterized by elevated INR, low platelet count, significant lactic acidosis, and hypoglycemia. She had a history of a benign ovarian tumor and was neither a smoker nor a drinker. The physical examination noted tachypnea, tachycardia, and large ecchymoses on her extremities but was otherwise unremarkable.<br /><br />Diagnostic tests showed a decrease in platelets, elevated lactic acid, and abnormal liver function tests. Despite an unrevealing bone marrow aspirate and blood cultures with no growth, CT imaging identified enlarged mediastinal lymph nodes, prompting an emergent ultrasound-guided biopsy.<br /><br />The patient was diagnosed with lymphoma, leading to type B lactic acidosis—a condition where cancer cells predominantly use anaerobic glycolysis for energy, even in the presence of oxygen, a phenomenon known as the Warburg effect. This metabolic change leads to increased glucose uptake and lactic acid production, contributing to severe acidosis and hypoglycemia, often seen in hematologic malignancies.<br /><br />DIC in malignancy is typically less severe than in sepsis but indicates serious illness. Standard interventions include chemotherapy specifically targeting the underlying malignancy, supportive care for acidosis, and blood product transfusions.<br /><br />Despite initiating treatment with chemotherapy agents and supportive measures like IV bicarbonate and glucose, the patient continued to deteriorate and succumbed to her illness after 19 days in the hospital. This case underscores the dire prognosis associated with the combination of DIC, lactic acidosis, and hypoglycemia in the context of cancer, highlighting the need for rapid diagnosis and intervention.

Keywords

disseminated intravascular coagulation

lymphoma

lactic acidosis

hypoglycemia

Warburg effect

hematologic malignancies

chemotherapy

glucose uptake

mediastinal lymph nodes

biopsy