SAT-667 - Diffuse Large B-Cell Lymphoma Presenting with Severe Hypertriglyceridemia in A Patient with Pre-Existing Dyslipidemia

Introduction: Severe hypertriglyceridemia (HTG) is an uncommon but clinically relevant paraneoplastic manifestation of diffuse large B-cell lymphoma (DLBCL). It may occur as a primary metabolic abnormality or lead to complications such as acute pancreatitis. Prior studies suggest that molecular subtypes such as EZB and BCL2 rearrangements are associated with higher rates of dyslipidemia. This case underscores HTG as a possible critical indicator of underlying malignancy, highlighting the necessity for thorough metabolic evaluations in lymphoma assessments.

Case presentation: A 54-year-old man with type 2 diabetes, hyperlipidemia, and prior abdominal aortic aneurysm (AAA) repair presented with severe HTG and abnormal abdominal imaging. Surveillance ultrasound incidentally identified a pelvic mass, and CT demonstrated multiple left external iliac and pelvic masses with borderline lymphadenopathy. Laboratory studies showed severely elevated triglycerides at 2,433 mg/dL, lipase 18 U/L, TSH 2.46 μIU/mL, creatinine 1.66 mg/dL, hemoglobin 8.6 g/dL, and reticulocytes 3.3%. Patient admitted to poor compliance with home fenofibrate, likely contributing to the degree of lipid elevation. Given concern for malignancy, a multidisciplinary workup was pursued. HTG was treated with insulin infusion, fenofibrate, rosuvastatin, and omega-3 fatty acids, with improvement to 802 mg/dL. Serum protein electrophoresis and free light chains were unremarkable. Biopsy of the pelvic mass demonstrated a lymphoproliferative disorder with mixed small and large lymphocytes. Immunophenotyping showed CD5-, CD10-, BCL6-, MUM1+, c-MYC-, BCL2+, and Ki-67 of 51–60%, consistent with non-germinal center DLBCL. The patient was started on R-CHOP with G-CSF support. Post-treatment imaging demonstrated complete remission.

Conclusion: DLBCL can cause paraneoplastic metabolic derangements, but severe hypertriglyceridemia is rare and underrecognized. Impaired triglyceride clearance and altered lipid metabolism are likely contributors, particularly in subtypes such as EZB. This association should be considered even in patients with pre-existing hypertriglyceridemia, as disproportionate or refractory elevations may signal underlying lymphoma and warrant prompt evaluation to avoid diagnostic delay.

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