Severe lactic acidosis and hypoglycemia as paraneoplastic manifestations of diffuse large B-cell lymphoma: a case-based review of hyper-Warburgism

Profound lactic acidosis and refractory hypoglycemia are rare but critical indicators of underlying malignancy. We report a case of diffuse large B-cell lymphoma presenting with the aforementioned metabolic derangements consistent with the Warburg effect and its extreme form, hyper-Warburgism. This phenomenon reflects aggressive tumor metabolism driven by aerobic glycolysis leading to excess lactate and glucose consumption. A comprehensive workup excluded infectious, ischemic, and metabolic causes, and the diagnosis was eventually confirmed via biopsy. Despite treatment, the disease rapidly progressed, leading to multiorgan failure. This case emphasizes the importance of recognizing atypical metabolic presentations as signs of aggressive malignancy because early identification of hyper-Warburgism can expedite oncologic evaluation, guide management, and potentially improve outcomes.