INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL) subtype worldwide, comprising 22% of newly diagnosed B-cell NHL cases in the United States. Notoriously aggressive, DLBCL develops quickly, variably, and often harbors in extra-nodal areas, like the gastrointestinal tract. DLBCL is curable, thus early diagnosis and initiation of aggressive treatment is imperative.

CASE PRESENTATION: We report a case of a 55-year-old Hispanic, veteran male with a history of mesenteric, non-Hodgkin’s lymphoma, status post-chemotherapy and post-surgical biopsy. The patient appeared to be in remission for 7 months, during which he stayed compliant with post-procedural follow-up care and lymphoma surveillance. During a routine follow-up appointment, physical examination is unremarkable and a computed Tomography (CT) scan is ordered, which shows an enlarged lesion with air and fluid, and a large cystic, mesenteric mass indicating possible small intestinal perforation. Positron Emission Tomography (PET) scan of the area reveals a radioactive ‘hot’ mass at the same site of previous lymphoma with possible encroachment into small intestine. Complete blood cell (CBC) unveils a waning hemoglobin level of 1.8 suggesting severe anemia. Though patient’s clinical presentation is silent, suspicion for threatened bowel and possible intestinal perforation prompt plan for immediate exploratory laparotomy. Upon laparotomy, the mass is visualized, and accompanied by a necrotic cystic mass. Further dissection shows a perforated proximal ileum. Surgical pathology of the mesenteric mass confirms high-grade lymphoma, indicated by positive CD20, CD10, and bcl-6.

FINAL DIAGNOSIS: The patient is diagnosed with an infected mesenteric cystic mass, recurrent high-grade lymphoma, and intestinal perforation.

MANAGEMENT/DISCUSSION: The presented case emphasizes the significance of continued care and management in patients with a history of gastrointestinal disease secondary to DLBCL, even when in remission or presenting clinically silent. In this case, it was the combination of clinical evaluation, lab work-up, and imaging that permitted discovery of a surgically acute small bowel. Thus, the case exemplifies the impact of thorough follow-up care in detection of a treatable yet acute event, especially when patients are seemingly asymptomatic. As a result, increased literary availability promoting practices of both preventative and curative care further facilitates positive patient prognostication.

 

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