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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. 87:32-36
- Publication Year :
- 2020
- Publisher :
- Medical Association of Nippon Medical School, 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 :
- Male
Critical Care
Multiple Organ Failure
Prednisolone
medicine.medical_treatment
Severity of Illness Index
law.invention
03 medical and health sciences
0302 clinical medicine
law
Antineoplastic Combined Chemotherapy Protocols
Humans
Medicine
Lactic Acid
Renal replacement therapy
Cyclophosphamide
business.industry
Organ dysfunction
General Medicine
Middle Aged
medicine.disease
Intensive care unit
Vascular Neoplasms
Renal Replacement Therapy
Tumor lysis syndrome
Respiratory failure
Doxorubicin
Vincristine
030220 oncology & carcinogenesis
Lactic acidosis
Anesthesia
030211 gastroenterology & hepatology
Hyperlactatemia
Lymphoma, Large B-Cell, Diffuse
medicine.symptom
Acidosis
Rituximab
Tumor Lysis Syndrome
business
Severe lactic acidosis
Subjects
Details
- ISSN :
- 13473409 and 13454676
- Volume :
- 87
- Database :
- OpenAIRE
- Journal :
- Journal of Nippon Medical School
- Accession number :
- edsair.doi.dedup.....036f8fe4097d831ead12280f603b5c36