ICU 中以脓毒症和难治性高乳酸血症为临床表现疑诊淋巴瘤 3 例并文献复习

Objective To explore the diagnosis and treatment of suspected lymphoma with sepsis and refractory hyperlactatemia as clinical manifestations in the intensive care unit (ICU). Methods The clinical data of 3 suspected lymphoma patients with sepsis and refractory hyperlactatemia as the main clinical manifestations in ICU of the Second Affiliated Hospital of Xi'an Jiaotong University from July 2019 to July 2022 were retrospectively analyzed. The 3 patients had persistent hyperlactatemia that could not be corrected after receiving conventional treatment for sepsis. Results One 63-year-old male patient was given sodium bicarbonate and continuous renal replacement therapy, but the lactate level continued to be >15.0 mmol/L. CT and magnetic resonance imaging of the abdomen suggested hepatosplenomegaly and splenic infarcts, and bone marrow aspiration and flow cytometry suggested the presence of abnormal monoclonal B lymphocytes, and he was suspected to have lymphoma; however, bone marrow biopsy was not performed because of the critical condition. The experimental chemotherapy was given, and the lactate level reduced to 1.6 mmol/L. One 60-year-old male patient developed septic shock, the circulation was stabilized after intensive anti-infective treatment, but the lactate level was still abnormal. The patient continued to have fever and low trilineage cells. Finally, the patient was clearly diagnosed as diffuse large B-cell lymphoma by PET-CT and bone marrow aspiration biopsy. One 70-year-old male patient was admitted to the hospital with a rash accompanied by fever, and initially, sepsis due to infection was considered, and the next-generation sequencing of the blood macro-genome suggested cytomegalovirus positive, the patient was consistent with the diagnosis of hemophagocytic syndrome. The symptoms improved after chemotherapy and anti-infective treatment, but the lactate level decreased and then increased again, and the patient was finally diagnosed as peripheral T-cell lymphoma. All 3 patients died due to the disease progression. Conclusions For patients with clinical manifestations of sepsis combined with refractory hyperlactatemia in ICU, lymphoma should be highly suspected when combined with trilineage cytopenia, and the secondary sepsis will interfere with the diagnosis and treatment of the primary disease at the beginning. The disease is characterized by ineffective correction of lactate level in the conventional way, and chemotherapy is the key; the mortality rate is high after the liver and spleen invasion.