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A Case Report of NK-Cell Lymphoproliferative Disease With a Wide Involvement of Digestive Tract Develop Into Epstein – Barr Virus Associated NK/T Cell Lymphoma in an Immunocompetent Patient

View Article: PubMed Central - PubMed

ABSTRACT

Epstein–Barr virus (EBV) plays an important role in various diseases. EBV-associated lymphoproliferative disease (LPD) is a rare disease with a canceration tendency. It is difficult to differentiate LPD with involvement of digestive tract from Crohn disease due to similar clinical and endoscopic manifestations. We present a case report of multiple ulcers with esophagus, small bowel and the entire colon involved, proved to be NK-Cell LPD, developed into EBV-associated NK/T Cell lymphoma, in an immunocompetent man who was initially misdiagnosed as Crohn disease.

This report underscores that intestinal ulcers should be cautiously diagnosed, for it sometimes could be a precancerous lesion.

No MeSH data available.


Related in: MedlinePlus

(A) An enhanced small intestine computed tomography shows segmental wall of right colon, ileocecal, and terminal ileum thickened with multiple small lymph nodes seen. (B) Gastroscopy found rough mucosa with a longitudinal ulcer on the lower esophagus. Colonoscopy revealed multiple jumping ulcers in the terminal ileum (C) and the entire colon (D).
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Figure 1: (A) An enhanced small intestine computed tomography shows segmental wall of right colon, ileocecal, and terminal ileum thickened with multiple small lymph nodes seen. (B) Gastroscopy found rough mucosa with a longitudinal ulcer on the lower esophagus. Colonoscopy revealed multiple jumping ulcers in the terminal ileum (C) and the entire colon (D).

Mentions: He had no weight loss at presentation. The physical examination revealed mild tenderness on right lower abdomen quadrant. Laboratory tests showed mild leukocytosis (11,700/mm3), mild anemia (11.9 g/dL), increased C-reactive protein (CRP) level (37.6 mg/dL), and mild hypoalbuminemia (37.3 g/L). Stool blood was positive. Negative HIV test, negative cytomegalovirus antibody (CMVAb)-IgM and EBVAb-IgM, and a week-positive CMVAb-IgM and EBVAb-IgG were revealed. T-SPOT was negative and no findings in chest computed tomography (CT). The abdominal CT indicated the walls of the right colon, ileocecum, and terminal jejunum thickened (Figure 1A). Gastroscopy found a longitudinal irregular ulcer on the lower esophagus (Figure 1B). Colonoscopy revealed multiple jumping ulcers on the terminal ileum and the entire colon (Figure 1C). Histological examinations of the biopsy samples from the esophagus, terminal ileum, and colon revealed ulcerated mucosa with lymphoid and inflammatory granulation tissue hyperplasia (Figure 2). It seemed that all the evidence pointed to a diagnosis of Crohn disease except his inexplicable high fever, often higher than 39°C since he was admitted. No abscess was found. So we hesitated for his anti-TNF treatment. Bone marrow biopsy gave negative report and no evidence supported a diagnosis of lymphoma.


A Case Report of NK-Cell Lymphoproliferative Disease With a Wide Involvement of Digestive Tract Develop Into Epstein – Barr Virus Associated NK/T Cell Lymphoma in an Immunocompetent Patient
(A) An enhanced small intestine computed tomography shows segmental wall of right colon, ileocecal, and terminal ileum thickened with multiple small lymph nodes seen. (B) Gastroscopy found rough mucosa with a longitudinal ulcer on the lower esophagus. Colonoscopy revealed multiple jumping ulcers in the terminal ileum (C) and the entire colon (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998401&req=5

Figure 1: (A) An enhanced small intestine computed tomography shows segmental wall of right colon, ileocecal, and terminal ileum thickened with multiple small lymph nodes seen. (B) Gastroscopy found rough mucosa with a longitudinal ulcer on the lower esophagus. Colonoscopy revealed multiple jumping ulcers in the terminal ileum (C) and the entire colon (D).
Mentions: He had no weight loss at presentation. The physical examination revealed mild tenderness on right lower abdomen quadrant. Laboratory tests showed mild leukocytosis (11,700/mm3), mild anemia (11.9 g/dL), increased C-reactive protein (CRP) level (37.6 mg/dL), and mild hypoalbuminemia (37.3 g/L). Stool blood was positive. Negative HIV test, negative cytomegalovirus antibody (CMVAb)-IgM and EBVAb-IgM, and a week-positive CMVAb-IgM and EBVAb-IgG were revealed. T-SPOT was negative and no findings in chest computed tomography (CT). The abdominal CT indicated the walls of the right colon, ileocecum, and terminal jejunum thickened (Figure 1A). Gastroscopy found a longitudinal irregular ulcer on the lower esophagus (Figure 1B). Colonoscopy revealed multiple jumping ulcers on the terminal ileum and the entire colon (Figure 1C). Histological examinations of the biopsy samples from the esophagus, terminal ileum, and colon revealed ulcerated mucosa with lymphoid and inflammatory granulation tissue hyperplasia (Figure 2). It seemed that all the evidence pointed to a diagnosis of Crohn disease except his inexplicable high fever, often higher than 39°C since he was admitted. No abscess was found. So we hesitated for his anti-TNF treatment. Bone marrow biopsy gave negative report and no evidence supported a diagnosis of lymphoma.

View Article: PubMed Central - PubMed

ABSTRACT

Epstein–Barr virus (EBV) plays an important role in various diseases. EBV-associated lymphoproliferative disease (LPD) is a rare disease with a canceration tendency. It is difficult to differentiate LPD with involvement of digestive tract from Crohn disease due to similar clinical and endoscopic manifestations. We present a case report of multiple ulcers with esophagus, small bowel and the entire colon involved, proved to be NK-Cell LPD, developed into EBV-associated NK/T Cell lymphoma, in an immunocompetent man who was initially misdiagnosed as Crohn disease.

This report underscores that intestinal ulcers should be cautiously diagnosed, for it sometimes could be a precancerous lesion.

No MeSH data available.


Related in: MedlinePlus