(254) Cancer’s Metabolic Hijack: A Case of the Warburg Effect

Introduction: The “Warburg effect” is a metabolic hallmark of cancer cells where aerobic glycolysis is preferred over oxidative phosphorylation, even in the presence of ample oxygen and functioning mitochondria. Genetic mutations and dysregulated pathways enhance glucose uptake and glycolysis, favoring cell growth over efficient ATP production. Consequently, cancer cells consume glucose at a higher rate, causing type-B lactic acidosis. Profound hypoglycemia from the “Warburg effect” is a rare phenomenon in the oncology world.

Description: A 39-year-old female diagnosed in 2023 with Natural killer/T-cell lymphoma and bulky cervical lymphadenopathy presented to the emergency department with pyrexia. She was undergoing chemotherapy but was lost to follow-up, leading to disease progression to leukemia. Upon presentation, laboratory findings revealed pancytopenia, hypoglycemia with glucose of 57 mg/dL, and a lactic acidosis of 4.9 mmol/L. Despite eating, she remained hypoglycemic and was placed on dextrose 10% infusion. A thorough Endocrinology workup found no underlying cause of her hypoglycemia. In addition, no infection source was identified in the urine analysis, chest X-ray, or blood cultures. Her lactic acid remained consistently over 10 mmol/L. On the fourth day, she was transferred to the ICU due to worsening lactic acidosis and hypoglycemia. She was switched to dextrose 20% infusion as her hypoglycemia persisted. Thereafter, she became more acidotic, and developed shock and possible hemoptysis. She required intubation and vasopressors. Bronchoscopy revealed inflammation but no bloody secretions in the airways. The bleeding was immediately found to be epistaxis, requiring placement of nasal packing. She developed DIC requiring blood transfusions, and oncology recommended against further chemotherapy due to shock and the severity of illness. On the seventh day, care was withdrawn.

Discussion: Early identification of this underrated effect can improve outcomes in patients with metabolic derangements. This condition indicates a poor prognosis, highlighting the need for clinical awareness and early intervention. Currently, aggressive chemotherapy is the only effective therapy. Understanding the Warburg effect can help develop targeted therapies and improve patient management.