P1292 - A Rare Case of Distal Ileitis Caused by Diffuse Large B-Cell Lymphoma in an Elderly Patient From Honduras

Jacob T. Newman, DO¹, Alison H. Hong, BA¹, Abdelrahman Dabash, MD¹, Jennie Zhang, DO¹, James Gehring, MD¹, Lei Lynn, MD², Sumona Bhattacharya, MD^3
1George Washington University, Washington, DC; ²George Washington Medical Faculty Associates, Washington, DC; ³George Washington University Hospital, Washington, DC

Introduction: Ileitis may present with non-specific symptoms such as abdominal pain, diarrhea, and weight loss. The differential diagnosis includes infections, Crohn’s disease (CD), drugs, and malignancy. Here we present a case of a patient who presented with distal ileitis and features initially concerning for infection or CD but was ultimately diagnosed with diffuse large B-cell lymphoma (DLBCL).

Case Description/Methods: A 74-year-old male from Honduras with a history of appendectomy and reported recent helminth infection presented to our tertiary academic medical center with abdominal pain, nausea, early satiety, weight loss, and night sweats. Labs revealed elevated WBC and inflammatory markers (ESR, CRP, fecal calprotectin), low hemoglobin, and evidence of chronic HBV and latent tuberculosis (TB). Abdominal CT demonstrated distal ileitis and narrowing of the terminal ileum. Ileocolonoscopy revealed normal terminal ileum however distal ileitis with a non-traversable stricture, cecal ulcerations and rectal erosions. Histopathologic examination of the ileum revealed diffuse atypical lymphohistiocytosis with positive stains for CD20, CD10, BCL6, consistent with a diagnosis of DLBCL. AFB and Fite stains were negative for mycobacteria. The patient underwent ileocecectomy.

Discussion: In our case of a 74-year-old man from Honduras presenting with non-specific symptoms, evidence of TB exposure, enteritis on imaging, and a distal ileal stricture with ileocolitis, the initial differential diagnosis was wide and included intestinal tuberculosis or other infections and CD. Ultimately, hemopathology evaluation was consistent with primary gastrointestinal non-Hodgkin lymphoma (PGINHL), specifically, DLBCL of the ileum. PGINHL is a rare subtype of non-Hodgkin lymphoma that most commonly occurs in the stomach or ileum where lymph tissue is abundant. This patient's risk factors for NHL include male sex, advanced age, and chronic hepatitis B. Hepatitis B has a known association with DLBCL, however the mechanism of this is unclear. Our patient was treated with isoniazid for latent TB, entecavir for chronic HBV, and was discharged with the plan to start R-CHOP chemotherapy.

This case highlights the broad differential diagnosis of ileitis and challenges in diagnosing intestinal lymphoma. Additionally, the association between chronic hepatitis B and DLBCL warrants further investigation.




Disclosures:


Jacob T. Newman, DO¹, Alison H. Hong, BA¹, Abdelrahman Dabash, MD¹, Jennie Zhang, DO¹, James Gehring, MD¹, Lei Lynn, MD², Sumona Bhattacharya, MD³. P1292 - A Rare Case of Distal Ileitis Caused by Diffuse Large B-Cell Lymphoma in an Elderly Patient From Honduras, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.