A case of malignant lymphoma originating in the small intestine complicated by hemophagocytic syndrome after surgery for perforation

Abstract

A 70-year-old man visited our hospital with a chief complaint of right lower quadrant pain. Since he had guarding in the right lower quadrant, and abdominal CT showed free intraperitoneal air in the upper abdomen, the patient was diagnosed with acute generalized peritonitis caused by gastrointestinal perforation, and emergency surgery was performed on the same day.
A 5-mm-diameter perforation was found in the ileum 55 cm proximal to the terminal ileum, and enlargement of mesenteric lymph nodes around the perforation site was observed.
The pathological sample showed diffuse proliferation and infiltration of atypical lymphocytes in all layers of the intestinal wall, which had lost its normal structure. Based on testing positive for CD20 and CD79a and negative for CD3, the patient was diagnosed with diffuse large B-cell lymphoma.
The patient's general condition worsened rapidly 23 days after surgery, and he died on the 24^th day. Autopsy showed intraperitoneal dissemination of malignant lymphoma. Hemophagocytosis by histiocytes was seen in the spleen and bone marrow, indicating hemophagocytic syndrome.
A case of malignant lymphoma originating in the small intestine that manifested with perforative peritonitis, was complicated postoperatively by hemophagocytic syndrome, and deteriorated rapidly is described with reference to the literature.