2026 Volume 46 Issue 3 Pages 487-491
Systemic lupus erythematosus (SLE) is a known risk factor for malignant lymphoma. A woman in her 40s with SLE who was receiving treatment with mycophenolate mofetil (MMF) and belimumab presented to our emergency department complaining of abdominal pain of sudden onset. Physical examination revealed abdominal muscle guarding and contrast-enhanced computed tomography (CT) of the abdominopelvic region revealed intra-abdominal free gas and thickening of the small intestinal wall. We performed emergency surgery, and intraoperative exploration revealed a small bowel perforation: a perforation of the jejunum was observed 40 cm distal to the ligament of Treitz, and partial resection of the small intestine and functional end-to-end anastomosis were performed. Postoperative histopathology led to the diagnosis of other iatrogenic immunodeficiency-associated lymphoproliferative disorders associated with MMF, specifically Epstein-Barr virus-positive diffuse large B-cell lymphoma. Chemotherapy was initiated postoperatively, but the patient developed a second bowel perforation 40 cm distally to the previous surgical site. In patients with SLE, the possibility of gastrointestinal perforation associated with malignant lymphoma and the potential for incomplete tumor resection during initial surgery must be considered.
