Lactic acidosis as the initial presentation of lymphoma: A case report and integrated analysis of clinical characteristics and prognostic factors

Type B lactic acidosis (LA), a rare yet fatal complication of lymphoma with poor prognosis, remains poorly characterized due to reliance on isolated case reports. To systematically delineate clinical characteristics and prognostic determinants in newly diagnosed lymphoma patients presenting with LA as the initial presentation, we conducted an integrated analysis synthesizing unpublished institutional cases with systematically identified cases from PubMed, Web of Science, and hospital databases. Demographic, clinical, laboratory, imaging, histopathological, and therapeutic intervention data were extracted. Prognostic correlates were evaluated using univariate and multivariate logistic regression, with predictive accuracy validated through receiver operating characteristic (ROC) curves. Among the 53 patients analyzed, the predominant manifestations included general malaise and gastrointestinal symptoms (62.3% each), with infrequent superficial lymph node enlargement (15.1%). Key biochemical abnormalities included hyperlactatemia (peak lactate: 15.89 ± 7.82 mmol/L) and elevated lactate dehydrogenase (60.4%). Imaging revealed lymph node enlargement (41.5%) and hepatic abnormalities (39.6%). Non-survivors were significantly older (P = 0.007), had a higher incidence of B-symptoms (P = 0.032), and were less likely to receive chemotherapy (P < 0.001). Chemotherapy emerged as the sole independent predictor of survival (multivariate odds ratio [OR] = 0.020; 95% confidence interval [CI]: 0.002-0.211; P = 0.001), validated by ROC curve analysis (sensitivity 92.0%, specificity 95.5%). This integrated analysis of a case and literature review underscores that LA signifies aggressive lymphoma with frequent advanced-stage disease. Although advanced age and B-symptoms predicted mortality, chemotherapy was the sole independent survival predictor in multivariate analysis.