University of Texas Medical Branch-Galveston Galveston, TX
Robinder Abrol, DO, Hamza Salim, DO, Jordan Malone, DO, Steven Cohn, MD, PhD University of Texas Medical Branch, Galveston, TX
Introduction: Common Variable Immunodeficiency (CVID) is a primary immune deficiency disease characterized by hypogammaglobulinemia. Patients with CVID typically present with recurrent sinopulmonary infections. Due to altered immunogenicity, patients are also susceptible to a wide range of gastrointestinal pathologies and lymphoid neoplasms. We present a case of Colonic Diffuse Large B-Cell Lymphoma (DLBCL) presenting as rectal bleeding in a patient with CVID.
Case Description/Methods: An 87-year-old male with past medical history notable for CVID on Immunoglobulin therapy diagnosed 4 years prior due to recurrent sinopulmonary and gastrointestinal infections, including Giardiasis and Clostridium difficile colitis, presented to clinic with intermittent rectal bleeding. The patient also complained of intermittent loose stools and significant abdominal bloating. Initial labs were notable for white blood cell count of 3.68 x10^3 /µL, hemoglobin 13.2 g/dL and platelets 159x10^3/µL. A recent CT scan of the abdomen and pelvis revealed anorectal wall thickening and adjacent lymphadenopathy concerning for malignancy.
Colonoscopy revealed a sessile non-obstructing large mass in the distal descending colon, another sessile non-obstructing large mass at the splenic flexure, and a fungating, friable partially obstructing large mass in the rectum 6 cm in length. Biopsies of these lesions confirmed DLBCL. Repeat CT scans of the chest, abdomen and pelvis did not reveal any other nodal or extranodal sites suspicious for malignancy. The patient was evaluated by oncology with plans to start chemotherapy.
Discussion: Although extranodal lymphomas are recognized diagnoses, DLBCL of the colon is an uncommon entity representing less than 15 percent of extranodal cases. Patients with CVID are at an increased risk of developing such malignancies, and in addition, these patients are at an increased risk of developing an array of gastrointestinal pathologies ranging from a sprue-like illness to an inflammatory bowel disease-type presentation. Our case demonstrates the importance of keeping a broad differential in the assessment of patients diagnosed with CVID presenting with gastrointestinal complaints.
Figure: Colon Mass
Robinder Abrol indicated no relevant financial relationships.
Hamza Salim indicated no relevant financial relationships.
Jordan Malone indicated no relevant financial relationships.
Steven Cohn indicated no relevant financial relationships.
Robinder Abrol, DO, Hamza Salim, DO, Jordan Malone, DO, Steven Cohn, MD, PhD. P1634 - Colonic Diffuse Large B-Cell Lymphoma (DLBCL) in a Patient With Common Variable Immunodeficiency Presenting as Rectal Bleeding, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.