Article ID: JNMS.2019_86-606
Intravascular lymphoma is a rare disease exhibiting multiple organ dysfunction, mainly due to tumor cell proliferation in small blood vessels. Few reports exist on the critical care management of intravascular lymphoma. We describe a rare case of multiple organ failure due to intravascular lymphoma with severe lactic acidosis wherein the patient survived. A 64-year-old man had impaired consciousness and was diagnosed with intravascular large B-cell lymphoma through 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. His mechanical ventilation and renal replacement therapy continued in the ICU and eventually his respiratory status and circulatory dynamics stabilized. However, his level of consciousness and hyperlactatemia did not improve until after doxorubicin, cyclophosphamide, vincristine, prednisolone, and rituximab chemotherapy. Although he experienced tumor lysis syndrome immediately after chemotherapy, his systemic condition gradually stabilized through continued critical care management consisting primarily of renal replacement therapy. He was weaned from ventilator support after undergoing a tracheotomy and moved into the general ward. Hematopoietic malignancies with hyperlactatemia have very poor prognosis; however, this patient's hyperlactatemia and level of consciousness were dramatically improved by the critical care management and chemotherapy. We report a rare case in which a patient with intravascular lymphoma involving multiple organ failure survived.
