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Successful Intensive Care Treatment of Severe Lactic Acidosis and Tumor Lysis Syndrome Related to Intravascular Lymphoma.
- Source :
-
Journal of Nippon Medical School = Nippon Ika Daigaku zasshi [J Nippon Med Sch] 2020 Mar 11; Vol. 87 (1), pp. 32-36. Date of Electronic Publication: 2019 Jul 15. - Publication Year :
- 2020
-
Abstract
- Intravascular lymphoma is a rare disease that progresses to multiple organ dysfunction caused primarily by tumor cell proliferation in small blood vessels. Few studies have investigated critical care management of intravascular lymphoma. We describe a rare case of multiple organ failure due to intravascular lymphoma with severe lactic acidosis in a patient who survived. A 64-year-old man with impaired consciousness was diagnosed as having intravascular large B-cell lymphoma by means of a random skin biopsy. The patient arrived at our hospital's intensive care unit (ICU) with impaired consciousness, respiratory failure that required mechanical ventilation, and lactic acidosis that required renal replacement therapy. Mechanical ventilation and renal replacement therapy were continued in the ICU, and his respiratory status and circulatory dynamics eventually stabilized. However, his impaired consciousness and hyperlactatemia did not improve until after the start of chemotherapy with doxorubicin, cyclophosphamide, vincristine, prednisolone, and rituximab. Although he developed tumor lysis syndrome immediately after chemotherapy, his systemic condition was gradually stabilized by continued critical care management primarily comprising renal replacement therapy. He was weaned from ventilator support after a tracheotomy and moved to the general ward. Hematopoietic malignancy with hyperlactatemia has a very poor prognosis; however, hyperlactatemia and impaired consciousness were dramatically improved in this patient by critical care management and chemotherapy.
- Subjects :
- Acidosis etiology
Cyclophosphamide administration & dosage
Doxorubicin administration & dosage
Humans
Male
Middle Aged
Multiple Organ Failure etiology
Prednisolone administration & dosage
Renal Replacement Therapy
Rituximab administration & dosage
Severity of Illness Index
Tumor Lysis Syndrome therapy
Vascular Neoplasms therapy
Vincristine administration & dosage
Acidosis therapy
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Critical Care
Lactic Acid
Lymphoma, Large B-Cell, Diffuse complications
Tumor Lysis Syndrome etiology
Vascular Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 1347-3409
- Volume :
- 87
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
- Publication Type :
- Academic Journal
- Accession number :
- 31308316
- Full Text :
- https://doi.org/10.1272/jnms.JNMS.2019_86-606