TY - JOUR
T1 - Iatrogenic immunodeficiency-associated lymphoproliferative disorder presenting as small bowel perforation
AU - Gunasingha, Rathnayaka Mudiyanselage Kalpanee Dhanushika
AU - Herrick-Reynolds, Kayleigh
AU - Sanford, Jeffrey A.
AU - Radowsky, Jason
N1 - Publisher Copyright:
© BMJ Publishing Group Limited 2024.
PY - 2024/3/29
Y1 - 2024/3/29
N2 - A woman in her late 50s on mycophenolate for limited systemic sclerosis presented with abdominal pain. Vital signs and investigative evaluations were normal. Cross-sectional imaging identified gastric and small bowel wall thickening, free fluid, and pneumoperitoneum. In the operating room, a small bowel perforation was found and resected. Postoperatively, immunosuppression was held and she completed a course of amoxicillin/clavulanate. She discharged home and re-presented on postoperative day 8 with seizures and was found to have a frontal brain mass which was biopsied. Pathology from both the resected bowel and brain biopsy demonstrated Epstein-Barr virus-positive B-cell lymphoproliferative disorder with polymorphic B-cell features. The patient’s immunosuppression was discontinued, and she was enrolled in a clinical trial for chemotherapy. Lymphoproliferative disorder can present years after immunosuppression initiation with either spontaneous perforation or solid tumour. Pathological assessment determines treatment options. Heightened concern for atypical clinical presentations in immunosuppressed patients is always warranted.
AB - A woman in her late 50s on mycophenolate for limited systemic sclerosis presented with abdominal pain. Vital signs and investigative evaluations were normal. Cross-sectional imaging identified gastric and small bowel wall thickening, free fluid, and pneumoperitoneum. In the operating room, a small bowel perforation was found and resected. Postoperatively, immunosuppression was held and she completed a course of amoxicillin/clavulanate. She discharged home and re-presented on postoperative day 8 with seizures and was found to have a frontal brain mass which was biopsied. Pathology from both the resected bowel and brain biopsy demonstrated Epstein-Barr virus-positive B-cell lymphoproliferative disorder with polymorphic B-cell features. The patient’s immunosuppression was discontinued, and she was enrolled in a clinical trial for chemotherapy. Lymphoproliferative disorder can present years after immunosuppression initiation with either spontaneous perforation or solid tumour. Pathological assessment determines treatment options. Heightened concern for atypical clinical presentations in immunosuppressed patients is always warranted.
UR - http://www.scopus.com/inward/record.url?scp=85189720559&partnerID=8YFLogxK
U2 - 10.1136/bcr-2023-257148
DO - 10.1136/bcr-2023-257148
M3 - Article
C2 - 38553024
AN - SCOPUS:85189720559
SN - 1757-790X
VL - 17
JO - BMJ Case Reports
JF - BMJ Case Reports
IS - 3
M1 - e257148
ER -