1/ #Medtwitter, a new case is here! Check out the last one here: bit.ly/33gz9pu
68M w/ fatigue, 20lb weight loss & dry cough x6 mo. No fevers but has frequent drenching night sweats.
How do you approach unintentional weight loss? Check out our schema below!
68M w/ fatigue, 20lb weight loss & dry cough x6 mo. No fevers but has frequent drenching night sweats.
How do you approach unintentional weight loss? Check out our schema below!
2/ No issues chewing or swallowing food, post-prandial pain, vomiting, or diarrhea.
VS T 37C BP 135/60 HR 82 RR 14 98% RA
On exam, he had a non-tender left 3x3 cm supraclavicular mass.
CBC and CMP were normal.
Lactate 5.3 mmol/L
VS T 37C BP 135/60 HR 82 RR 14 98% RA
On exam, he had a non-tender left 3x3 cm supraclavicular mass.
CBC and CMP were normal.
Lactate 5.3 mmol/L
3/ Elevated lactate is surprising given the patient’s story.
Take a minute to reflect on less uncommon causes of elevated lactate.
Looking at this schema through the lens of knowing the patient has a supraclavicular mass, does it filter the diagnoses in this schema?
Take a minute to reflect on less uncommon causes of elevated lactate.
Looking at this schema through the lens of knowing the patient has a supraclavicular mass, does it filter the diagnoses in this schema?
4/ A work up for infection revealed:
Blood cultures NGTD
UA wnl
CXR - diffuse patchy opacities
CT chest - nodules distributed in a perilymphatic distribution
Do you have an approach to lung nodules? Check out one of our favorites by @LekshmiMD, @jackpenner & @dminter89!
Blood cultures NGTD
UA wnl
CXR - diffuse patchy opacities
CT chest - nodules distributed in a perilymphatic distribution
Do you have an approach to lung nodules? Check out one of our favorites by @LekshmiMD, @jackpenner & @dminter89!
5/ Patient remained afebrile with stable vital signs.
HIV and quantiferon are checked and were negative.
Despite 3L of NS and high dose thiamine repletion, his lactic acidosis persisted.
Lactic acid 5.1 mmol/dL
HIV and quantiferon are checked and were negative.
Despite 3L of NS and high dose thiamine repletion, his lactic acidosis persisted.
Lactic acid 5.1 mmol/dL
6/ A CT abdomen with contrast was pursued and returned as negative for vessel occlusion or stenosis but showed diffuse retroperitoneal bulky lymphadenopathy.
Excisional lymph node biopsy of supraclavicular LN revealed diffuse large B-cell lymphoma.
Excisional lymph node biopsy of supraclavicular LN revealed diffuse large B-cell lymphoma.
7/ The likely cause of the pt’s persistent lactate? Warburg Effect!
8/ Warburg Effect occurs when cancer cells preferentially use glycolysis leading to type B lactic acidosis. PET-CT makes use of this important difference: cancers cells take up more glucose than the surrounding tissues!
9/ Thank you for following this case with us!
For more on Warburg effect, we love this incredibly educational tweetorial by @tony_breu: bit.ly/33cj7x6
For more on Warburg effect, we love this incredibly educational tweetorial by @tony_breu: bit.ly/33cj7x6
