A 63‐year‐old female with past medical history of meningioma was admitted with one‐week history of swelling, watering, painful movements and vision loss in right eye. She also had generalized weakness, 15 lb weight loss, anorexia, nausea, crampy abdominal pain and diarrhea. Her right eye was proptotic with visual acuity to hand movement only, intraocular pressure of 72mmHg and severly restricted range of motion. Patient was orthostatic and required resuscitatation. Her blood lactic acid level was 8.8. CT scan of orbits showed extensive soft tissue mass in retrobulbar portion of right orbit causing mass effect.(Image 1) CT scan of abdomen and pelvis showed ascites, multiple splenic lesions, retroperitoneal lymphadenopathy and a mass along the left external iliac chain. Bedside orbital decompression followed by emergent orbitotomy and exploration with tissue biopsy was performed. Biopsy of left groin mass was also done. A pathological dignosis of burkitt's lymphoma was made on both tissue specimens. Chemotherapy was started immediately which resulted in improvement in abdominal symptoms, lactic acidosis and proptosis. She, however, failed to regain any significant vision in her right eye.
Burkitt's lymphoma, a Non‐Hodgkin's lymphoma, occurs in an endemic (African) form, a sporadic form, and a third form seen among HIV patients. The sporadic form usually presents with abdominal findings. It is rare in adults, making up less than 1% of non‐Hodgkin's lymphomas. Typical age of presentation is less than 35 years. Sporadic burkitt's lymphoma presenting as proptosis is extremely rare, with very few previous reports. Lactic acidosis is a rare complication of burkitt's lymphoma. Our literature search showed only three reported cases of Burkitt's lymphoma‐induced lactic acidosis. It is a highly aggressive neoplasm, and an urgent diagnosis, staging and treatment is important. In our case, we were able to make a preliminary dignosis and start treatment within 12 hours of hospital admission.
Author Disclosure Block:
S. Saroha, None; G. Mehta, None; E. Deppert, None.