Diffuse Large B-Cell Non-Hodgkin Lymphoma Presenting as Acute Pancreatitis

Authors:
Claudia Gordillo, DO
Aventura Hospital, Miami, Florida

Wilson B. Pfeiffer, DO
Brooke Army Medical Center, San Antonio, Texas

Alixandria A. Fiore, DO
University of Texas Health Science Center at San Antonio, Texas

Roberto Comperatore, MD
Palmetto General Hospital, Miami, Florida

Nuria Lawson, MD
Palmetto General Hospital, Miami, Florida

Luis C. Rey, MD
Palmetto General Hospital, Miami, Florida

Syed A. A. Rizvi, PhD, MS, MBA
Hampton University School of Pharmacy, Hampton, Virginia

Mileydis Alonso, DO
Cleveland Clinic Florida, Weston, Florida

Andres Rodriguez, DO
University of Miami–Jackson Memorial Hospital, Miami, Florida

Citation:
Gordillo C, Pfeiffer WB, Fiore AA, Comperatore R, Lawson N, Rey LC, Rizvi SAA, Alonso M, Rodriquez A. Diffuse large B-cell non-Hodgkin lymphoma presenting as acute pancreatitis. Consultant. 2019;59(10):313-315.

A 70-year-old man with a past medical history of hyperlipidemia, benign prostatic hyperplasia, and cholecystectomy presented to the emergency department (ED) with abdominal pain, vomiting and abdominal distention for the past 9 days.

He stated that the pain was localized to the epigastric region and was constant and bloating in nature. He also reported 3 episodes of vomiting nonbloody, dark, bilious fluid and reported constipation for several days. He denied any episode of hematochezia; however, he stated that he had experienced straining with bowel movements, resulting in “string-like, pale” stools. The patient denied unexpected weight loss and current or previous use of alcohol, tobacco, of illicit drugs. His family history included a father who died of colon cancer at age 78. He had undergone a colonoscopy 5 years prior, the results of which were negative for gastrointestinal tract pathology.

Physical examination. The patient’s abdomen was tender to both light and deep palpation in all 4 quadrants and was distended and not soft upon palpation. There was no rebound tenderness or voluntary or involuntary guarding of the abdomen, and no palpable masses were found on palpation. The abdomen was dull to percussion in all 4 quadrants. Bowel sounds were present in all 4 quadrants. Anasarca was appreciated, with the most affected areas being the lower extremities and scrotum. The patient was afebrile without leukocytosis and was hemodynamically stable.

Hospital course of stay. The patient was provided intravenous medication for pain upon presentation to the ED. A computed tomography (CT) scan of the abdomen revealed diffusely enlarged and edematous pancreas with surrounding soft tissue stranding and infiltration, along with several adjacent vessels, representing severe pancreatitis (Figure 1).

Figure 1. Axial CT image of interstitial edematous pancreatitis.