P2259 - Plasmablastic Lymphoma in a Patient with Treatment Refractory Ulcerative Colitis

Abraham Ifrah, MD, MS¹, Christopher Kasia, MD¹, Yekaterina Belogrivtseva, MD¹, Adam C. Ehrlich, MD, MPH^2
1Temple University Hospital, Philadelphia, PA; ²Lewis Katz School of Medicine at Temple University, Philadelphia, PA

Introduction: Plasmablastic lymphoma (PBL) is rare and aggressive with a survival rate less than 14 months. There have been 9 documented cases of PBL in Crohn's disease (CD) and 2 in ulcerative colitis (UC). Here we present the third case of PBL in UC and the first while on ustekinumab.

Case Description/Methods: A 45-year-old man with treatment-refractory ulcerative colitis on ustekinumab for 8 months presented to the emergency department for 1 month of fever, night sweats, fatigue, weight loss and 1-day of severe abdominal pain. His prior UC history included prior treatment failure to azathioprine, infliximab, adalimumab, golimumab, and tofacitinib. He had been treated with prednisone at varying doses for >20 years. He was started on ustekinumab with partial clinical response and successfully tapered off budesonide and to a minimal dose of prednisone. Fecal calprotectin improved from 4800ug/g to 735ug/g but follow-up colonoscopy remained Mayo score 3 with minimal improvement in inflammation (Fig A,B). Based on his refractory disease and presence of low grade dysplasia on biopsies, he underwent a total abdominal colectomy. Surgical pathology was consistent with stage IV PBL. Histologic examination showed the malignancy was isolated to the submucosa without mucosal infiltration (Fig F,G). Despite a course of EPOCH therapy, he had recurrence of his disease and subsequently died 10 months after his initial diagnosis.

Discussion: There are 2 previously reported cases of PBL in UC. To our knowledge this is the first definite case of PBL in UC without a defined mass limited to the submucosa and the first patient with UC on ustekinumab to develop PBL. While our patient had clinical improvement after starting ustekinumab, he had long-standing severe and refractory disease. Although ustekinumab has not been associated with PBL, we suspect this patient’s long history on anti-TNFs and steroid use increased his risk of developing PBL. This case represents an unusual malignant complication of long-standing immunosuppressive therapy that can be seen in patients with IBD.



Disclosures:


Abraham Ifrah, MD, MS¹, Christopher Kasia, MD¹, Yekaterina Belogrivtseva, MD¹, Adam C. Ehrlich, MD, MPH². P2259 - Plasmablastic Lymphoma in a Patient with Treatment Refractory Ulcerative Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.