[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-432417-105":59,"doc-detail-432417-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","clinical-warburg-effect-in-a-primary-cutaneous-lymphoma","CLINICAL WARBURG EFFECT IN A PRIMARY CUTANEOUS LYMPHOMA","","Primary cutaneous lymphomas are skin-limited extranodal B- and T-cell malignancies, with primary cutaneous B-cell lymphomas comprising about 20% of cases. Warburg effect reflects metabolic reprogramming in which tumor cells preferentially convert glucose to lactate despite adequate oxygen, potentially leading to life-threatening type B lactic acidosis and refractory hypoglycemia. This report presents an 84-year-old woman with rapidly progressive facial and limb nodules, recurrent hypoglycemia, profound lactic acidosis, and fatal systemic intravascular lymphoma dissemination confirmed at autopsy.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/clinical-warburg-effect-in-a-primary-cutaneous-lymphoma/432417/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/clinical-warburg-effect-in-a-primary-cutaneous-lymphoma/432417.png","ImageObject",300,407,{"name":92,"@type":93},"Jasmine","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the clinical Warburg effect and why is it dangerous?","Question",{"text":113,"@type":114},"It is a metabolic shift where tumor cells convert glucose to lactate despite adequate oxygen, driving type B lactic acidosis and refractory hypoglycemia. These complications can become life-threatening, as in this case.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the patient present clinically?",{"text":118,"@type":114},"An 84-year-old woman developed four weeks of fatigue and a rapidly progressive eruption of indurated, violaceous nodules on the face, cervicothoracic region, and arms.",{"name":120,"@type":111,"acceptedAnswer":121},"What did pathology show about lymphoma spread?",{"text":122,"@type":114},"Skin biopsy demonstrated large atypical B-cell–appearing lymphoid cells, while autopsy showed exclusive intravascular localization in multiple internal organs without parenchymal infiltration or mass formation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},432417,1790863756,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336478487870,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Correspondence  \nCLINICAL WARBURG EFFECT IN A PRIMARY CUTANEOUS LYMPHOMA  \nFrancisco Martins1a, Guilherme Fontinha2, José Magalhães3, José Carlos Cardoso1, Joana Calvão1  \n1 Dermatology Department, University Hospital, Coimbra’s Local Health Unit, Praceta Professor Mota Pinto, Celas, 3004-561, Coimbra, Portugal,  \n2 Anatomic Pathology Department, University Hospital, Coimbra’s Local Health Unit, Praceta Professor Mota Pinto, Celas, 3004-561, Coimbra, Portugal, 3 Internal Medicine Department, University Hospital, Coimbra’s Local Health Unit, Praceta Professor Mota Pinto, Celas, 3004-561, Coimbra, Portugal  \nKeywords: Lymphoma, Large B-Cell, Diffuse, Lactic Acidosis, Hypoglycemia, Clinical Warburg Effect, Primary Cutaneous Lymphoma  \n[https://doi.org/10.46989/001c.15481](https://doi.org/10.46989/001c.15481)1  \n\n| Clinical Hematology International\u003Cbr>Vol. 8, Issue 1, 2026 |  |\n| --- | --- |\n| Primary cutaneous lymphomas are a subset of extranodal B-and T-cell malignancies characterized by skin-limited involvement at the time of diagnosis.1 Among these, primary cutaneous B-cell lymphomas (PCBCLs) comprise roughly 20% of cases and include both indolent subtypessuch as marginal zone lymphoma and follicle center lymphoma -and more aggressive variants – such as primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) .1‑3 When cases lack defining features, the diagnosis of primary cutaneous diffuse large B-cell lymphoma, not otherwise specified (PCDLBCL-NOS), is applied.1 Intravascular large B-cell lymphoma (IVLBCL) is a systemic lymphoma defined by tumor cell confinement to vessel lumina, but is sometimes considered alongside PCBCLs due to its frequent cutaneous presentation.4,5\u003Cbr>The Warburg effect-a form of metabolic reprogramming in which tumor cells preferentially convert glucose to lactate despite adequate oxygen6 – is a hallmark of cancer. Though often undetectable, this shift may cause refractory hypoglycemia and type B lactic acidosis in high-grade malignancies-a life-threatening complication known as clinical Warburg effect.7 This is mechanistically distinct from tumor lysis syndrome (TLS), which results from acute cell death and release of intracellular contents.8 Unlike TLS, the Warburg effect is driven by sustained tumor metabolism and can occur in the absence of treatment.\u003Cbr>We present a rare case of a primary cutaneous lymphoma manifesting with a clinical Warburg effect. An 84-year-old woman with no significant medical history presented with four weeks of fatigue and a rapidly progressive eruption of indurated, violaceous nodules over the face, cervicothoracic region, and arms. Laboratory evaluation revealed elevated lactate dehydrogenase (1786 IU/L) and β2-microglobulin (8.94 mg/L), with otherwise unremarkable hematologic and biochemical parameters.\u003Cbr>During hospitalization, she developed recurrent hypoglycemia, initially diet-responsive but later requiring IV glucose. On day 5, she became acutely disoriented and | tachypneic. Arterial blood gas analysis revealed profound lactic acidosis: pH 6.90, bicarbonate 4.9 mmol/L, and serum lactate 21.1 mmol/L, with preserved oxygenation (pO₂ 88 mmHg) . Electrolytes, including potassium and phosphate, remained within normal limits. Despite prompt administration of intravenous bicarbonate and glucose, the patient’s condition deteriorated rapidly, and she died within one hour.\u003Cbr>A complete autopsy was performed to clarify the cause of rapid clinical deterioration. Gross examination revealed over 50 violaceous nodules distributed across the trunk, face, and upper limbs, with no significant abnormalities identified in internal organs. Histopathologic analysis of a representative skin lesion demonstrated a dense dermal and subcutaneous infiltrate (Figure 1A) composed of large atypical lymphoid cells with features of centroblasts and immunoblasts (Figure 1B) . Immunohistochemistry showed positivity for CD20 and BCL2, and negativity for CD10, BCL6, and MUM1 . The Ki-6","cbCaiqPpC6nFIOnv","https://ap.wps.com/l/cbCaiqPpC6nFIOnv","pdf",1737444,"English","# Clinical Warburg effect in primary cutaneous lymphoma\n## Background and rationale\n## Case presentation\n## Hospital course and death\n## Autopsy and pathological findings\n## Diagnosis and interpretation","[{\"question\":\"What is the clinical Warburg effect and why is it dangerous?\",\"answer\":\"It is a metabolic shift where tumor cells convert glucose to lactate despite adequate oxygen, driving type B lactic acidosis and refractory hypoglycemia. These complications can become life-threatening, as in this case.\"},{\"question\":\"How did the patient present clinically?\",\"answer\":\"An 84-year-old woman developed four weeks of fatigue and a rapidly progressive eruption of indurated, violaceous nodules on the face, cervicothoracic region, and arms.\"},{\"question\":\"What did pathology show about lymphoma spread?\",\"answer\":\"Skin biopsy demonstrated large atypical B-cell–appearing lymphoid cells, while autopsy showed exclusive intravascular localization in multiple internal organs without parenchymal infiltration or mass formation.\"}]","CLINICAL WARBURG EFFECT IN A PRIMARY CUTANEOUS LYMPHOMA | PDF",1790659500,13]