23 October 2023
: Case report 
An Elusive Diagnosis: Diffuse Large B-Cell Lymphoma Masquerading as Acute Liver Failure with Persistent Lactic Acidosis
Challenging differential diagnosis, Rare disease
Prabasha Weeraddana
1F*, Oluwole Odujoko2F, Shubhneet Bal2F, Niwanthi Mannapperuma1F, David Maslak1E, Gunjan Gupta2ADEF
DOI: 10.12659/AJCR.941270
Am J Case Rep 2023; 24:e941270
Table 1. Day-to-day laboratory findings (Day 0 is the day of admission).
| Test name | Day 0 | Day 1 | Day 7 | Day 8 | Day 10 | Day 12 |
|---|---|---|---|---|---|---|
| WBC (10/µL) | 22 | 18.6 | 13.5 | 16.4 | 11.8 | 6.4 |
| Hg (g/dL) | 9.3 | 8.2 | 8.3 | 8.8 | 8.4 | 6.6 |
| Platelets (10/µL) | 164 | 175 | 109 | 107 | 74 | 29 |
| AST (U/L) | 94 | 63 | 212 | 328 | 751 | 386 |
| ALT (U/L) | 75 | 56 | 78 | 101 | 20 | 174 |
| ALP (U/L) | 201 | 168 | 293 | 318 | 398 | 258 |
| Total bilirubin (mg/dL) | 0.8 | 0.5 | 1.7 | 2.5 | 5 | 7.9 |
| INR | – | – | – | 6.35 | 4.64 | 7.04 |
| aPTT (s) | 29.2 | 32 | – | 66.4 | – | 60.5 |
| Fibrinogen (mg/dL) | – | – | – | 292 | – | 167 |
| LDH (IU/L) | – | 1093 | >2500 | >2500 | >2500 | >2500 |
| BUN (mg/dL) | 18 | 18 | 12 | 13 | 22 | 25 |
| Serum creatinine (mg/dL) | 1.55 | 1.29 | 1.63 | 1.63 | 2.12 | 2.39 |
| Ammonia (µmol/L) | – | – | – | 51 | 117 | 69 |
| Lactic acid (mmol/L) | 3.9 | 1.7 | 4.1 | 4.2 | 4.1 | 7.3 |
| D-Dimer | – | – | – | >20000 | – | 17440 |