AccScience Publishing / CP / Online First / DOI: 10.36922/CP025160030
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CASE SERIES

Severe lactic acidosis in association with CD5+ large B-cell lymphoma

Kenji Miki1 ,  Yasuhiro Kazuma2 ,  Arihiro Masuda1 ,  Shinnosuke Itoh1 ,  Naoyuki Anzai2 ,  Kazuhiro Sato3 ,  Yoshiki Terada4 ,  Ayaka Fukui5 ,  Naoki Nakajima5 ,  Michihiko Fukui6 ,  Yutaka Shimazu7 ,  Shinsaku Imashuku8*
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1 Department of General Medicine, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
2 Department of Hematology, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
3 Division of Hepatology, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
4 Department of Internal Medicine, Katano Hospital, Katano, Kyoto, Japan
5 Department of Diagnostic Pathology, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
6 Intensive Care Unit, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
7 Department of Early Clinical Development, Graduate School of Medicine, Kyoto University, Kyoto, Japan
8 Department of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
CP, 025160030 https://doi.org/10.36922/CP025160030
Received: 19 April 2025 | Revised: 29 July 2025 | Accepted: 1 September 2025 | Published online: 13 October 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Lactic acidosis is classified into type A and type B. In cases of type B lactic acidosis, it is important to consider underlying lymphomas, mostly B-cell types, such as intravascular large B-cell lymphoma (IVLBCL) or diffuse large B-cell lymphoma. Cluster of differentiation (CD) 5+ large B-cell lymphoma (LBCL) is well-known for its aggressive nature. We report here two cases of CD5+ LBCL that showed severe lactic acidosis (11.2 mmol/L and 15.9 mmol/L, respectively; reference range: 0.6–1.7) with hypoglycemia. Case 1 was a 79-year-old female who presented with multiple organ failure. CD5+ IVLBCL was diagnosed through a random skin biopsy in this patient. Case 2 was a 78-year-old female with bone marrow involvement by CD5+ LBCL cells and liver failure. The patient was also diagnosed pathologically as IVLBCL by liver biopsy. Both patients were under ventilator management and high-flow continuous hemodialysis and filtration. Plasma exchange was also employed. An anti-lymphoma regimen (a 50% dose-reduced etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) was introduced on day 11 and day 2 of hospitalization for cases 1 and 2, respectively. In Case 1, lactic acidosis was normalized within day 17, and the patient survived longer than 8 weeks, while in Case 2, lactic levels did not improve until her death on day 16 of hospitalization. In conclusion, prompt recognition of type B lactic acidosis and early diagnostic biopsy are essential for improving outcomes in aggressive CD5+ IVLBCL, highlighting the need for novel therapeutic strategies.

Graphical abstract
Keywords
CD5+ large B-cell lymphoma
Lactic acidosis
Intravascular large B-cell lymphoma
Random skin biopsy
Liver biopsy
Chemotherapy
Ventilator management
Continuous hemodialysis and filtration
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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