Abdominal Lymphoma Presenting as Terminal Ileitis: A Case Report.

Authors:
Michael J Absalon
Michael J Absalon
University of Cincinnati College of Medicine
George C Koberlein
George C Koberlein
Cincinnati Children's Hospital Medical Center
Selena Hariharan
Selena Hariharan
Cincinnati Children's Hospital Medical Center
Cincinnati | United States

J Emerg Med 2019 Apr 16. Epub 2019 Apr 16.

Department of Emergency Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Background: Most pediatric patients with lymphoma do not have classic symptoms of fever, night sweats, and weight loss. Lymphoma can present as vague symptoms and may mimic common pediatric abdominal emergencies. In this case report, we present a child who presented with abdominal pain and who was initially misdiagnosed as having a surgical emergency.

Case Report: An 11-year-old previously healthy male was referred to the pediatric emergency department after he presented to an outside hospital with 3 days of right lower quadrant pain and 1 episode of diarrhea. The initial concern was appendicitis. He had a computed tomography scan of the abdomen and pelvis that showed thickening of the bowel wall, peritoneal thickening, and a right pleural effusion. His laboratory assessments were only notable for a mildly elevated lactate dehydrogenase level of 506 units/L. He had a colonoscopy, and biopsy specimens obtained from the terminal ileum and cecum were negative. He developed worsening symptoms, and subsequently underwent laparoscopic biopsy procedures of the omentum and terminal ileum, which were consistent with Burkitt lymphoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We discuss the important oncologic findings of pediatric lymphoma, including oncologic emergencies and important laboratory and imaging tests that providers should consider while in the emergency department. This case highlights how pediatric lymphoma can mimic common pediatric pathologies providers often encounter in the emergency department.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S07364679193013
Publisher Site
http://dx.doi.org/10.1016/j.jemermed.2019.03.004DOI Listing
April 2019
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