P0094 - Obstructive Jaundice: An Unusual Presentation of B-cell Lymphoma

Reyshley Ramos-Marquez, MD, Esteban Grovas-Cordovi, MD, Pedro Rosa-Cortes, MD, Kiara Ortiz-Camacho, MD, Eduardo Acosta-Pumarejo, MD, Carla Blanco, MD, Jose Martin-Ortiz, MD, FACG
VA Caribbean Healthcare System, San Juan, Puerto Rico

Introduction: Jaundice constitutes a common presentation of a variety of disorders that include biliary obstruction, bilirubin overproduction or impaired conjugation. Obstructive jaundice on its own can be the result of several etiologies, however this could be considered a rare complication of lymphoma. We present a case of obstructive jaundice as the initial presentation B-cell lymphoma.

Case Description/Methods: Case of a 67-year-old male without major medical history that was consulted to our service for evaluation of worsening jaundice, pruritus, abdominal pain and unintentional weight loss of 2 months of evolution. The laboratories were relevant for direct hyperbilirubinemia, elevated transaminases with a cholestatic pattern. Physical examination revealed tenderness upon deep palpation in the right upper quadrant, scleral icterus, jaundice, and cervical lymphadenopathy. A CT scan revealed a large mass encasing the portal venous inseparable from the pancreatic head and medial wall of the duodenum. Lymph node biopsy was remarkable for a diffuse large B-cell lymphoma. ERCP was performed and a long stricture at the level of the common hepatic duct was noted, sphincterotomy and plastic stent placement were done. Subsequent ERCP with Spyglass direct visualization and directed biopsies due to distal common bile duct stricture resulted negative for malignancy. The patient was started on chemotherapy with partial response, but unfortunately malignancy recurred and despite salvage therapy and CAR-T cell therapy patient died due to multiple complications.

Discussion: Obstructive jaundice is a rare initial presentation for lymphoma and is seldom considered as part of the differential diagnosis. This shows why proper history and physical examination can help to guide clinicians in the proper diagnosis and management of such cases in which the clinical presentation and initial imaging can lead us to think of an entirely gastrointestinal and biliary tract as the etiology, rather than other causes such as lymphoma. This case shows how the initial clinical presentation was misleading but by the use of other modalities like fine needle aspiration of a neck nodule the correct diagnosis was made and the importance of multidisciplinary approach.


Disclosures:


Reyshley Ramos-Marquez, MD, Esteban Grovas-Cordovi, MD, Pedro Rosa-Cortes, MD, Kiara Ortiz-Camacho, MD, Eduardo Acosta-Pumarejo, MD, Carla Blanco, MD, Jose Martin-Ortiz, MD, FACG. P0094 - Obstructive Jaundice: An Unusual Presentation of B-cell Lymphoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.