A CASE OF HYPOGLYCEMIA, LACTIC ACIDOSIS, AND HEMATOLOGIC MALIGNANCY

Objective: To report a case of chronic and persistent hypoglycemia and lactic acidosis in a 74-year-old military veteran. Methods: The clinical, laboratory, radiologic, and cytogenetic details of the case are presented, followed by a discussion of the related literature. Results: The patient was treated for septicemia without evidence of infection. Mitochondrial dysfunction was explored because of the possibility of environmental exposures during military service. On bone marrow biopsy, he was found to have immature B-cell lymphoma and myelodysplasia. There have been 28 previously reported cases of non-Hodgkin lymphoma-induced lactic acidosis in adult patients (11 with hypoglycemia), which has been associated with a high mortality rate. Conclusion: Our case is unique because, to our knowledge, it is the first reported case of immature B-cell lymphoma/leukemia and myelodysplasia with a complex karyotype based on extensive cytogenetic studies in a patient presenting with hypoglycemia, lactic acidosis, and central nervous system involvement by lymphoma. (Endocr Pract. 2010;16:241-243)