Learning Objective Recognize the ability of lymphoproliferative disorders to present as non-cytokine mediated multiorgan dysfunction syndrome and hypotension mimicking sepsis.
Case Information A 58-year-old Puerto Rican female was admitted for respiratory distress and lower extremity edema. The patient had been admitted twice in the preceding 6 weeks for community-acquired pneumonia. She was being evaluated for a collagen vascular disease due to an ANA of 1:1280, megaesophagus with motility disorder and interstitial pattern on chest radiograph. Two days after admission, the patient developed acute respiratory failure, lactic acidosis, hyperkalemia, acute renal failure, hypotension, and coagulopathy. Aggressive resuscitation temporarily stabilized the patient. Blood, urine, and sputum cultures were negative. A CT of the abdomen and pelvis suggested acute chylocystitis and a percutanous drain was placed but the culture was negative. Culture of the bone marrow biopsy was negative. Fourteen days after transfer to the ICU the patient was unable to maintain homeostasis and care was withdrawn. Final bone marrow pathology was consistent with a diffuse large B-cell lymphoma.
Discussion Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin's lymphoma and is clinically aggressive. The median age at presentation is 64 years and most commonly presents as an enlarging mass in the neck or abdomen. Extranodal involvement can be seen in up to half of patients but organ failure has not been widely reported.
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