Successful Treatment of Severe Type B Lactic Acidosis ina Patient with HIV/AIDS-Associated High-Grade NHL

Type B lactic acidosis is a rare metabolic complication sometimes associated with hematologic malignancies. When present, thistype of lactic acidosis is most commonly seen in patients with high-grade lymphomas or leukemias and is usually indicative ofa dismal prognosis. We report a case of a 27-year man with acquired immunodeficiency syndrome (AIDS) that presented withbilateral lower extremity swelling, an abdominal mass, and weightloss. His lab values showed elevated anion gap with lactic acidosisand computed tomography (CT) of the abdomen showed a large soft-tissue mass arising from the left hepatic lobe. Biopsy ofthe abdominal mass demonstrated a high-grade diffuse large B-cell lymphoma. The patient’s lactic acidosis resolved after startingchemotherapy, and a complete response was evident on PET-CT after a third cycle of rituximab, etoposide, prednisone, vincristine,cyclophosphamide, and doxorubicin (EPOC-RR). Care-givers should be aware of the implications of lactic acidosis associated withmalignancy and the need for prompt diagnosis and treatment.