Intestinal stenosis developed after a complete response to chemotherapy in a patient with Crohn's disease and lymphoma of the jejunum

Rev Esp Enferm Dig. 2024 Sep;116(9):502-504. doi: 10.17235/reed.2023.10004/2023.

Abstract

An increased risk of hematologic malignancies secondary to long-term immunomodulators and biologics has been described in patients with inflammatory bowel disease1. Here, we present a case of jejunal stricture after chemotherapy treatment in a patient with ileal Crohn´s disease (CD) and jejunal lymphoma. The patient was a 32-year-old male with ileal CD in remission presenting with abdominal pain and distension. Abdominal computed tomography (CT) showed a poorly defined mass in the proximal jejunum, and positron emission tomography (PET) - CT showed hypermetabolic activity at that level. An upper endoscopy evidenced an indurated, friable circumferential mass causing a significant reduction of the intestinal lumen. Histological and cytometry findings led to a diagnosis of large B cell lymphoma, for which the patient received standard treatment (R-CHOP and IPI), achieving complete response. Eight months later, the patient reported abdominal pain and distention. Abdominal CT showed a thickening of a short segment of the proximal jejunum. An upper endoscopy showed a punctiform stenosis, while multiple biopsies showed neither histological recurrence of lymphoma nor signs of IBD. The patient was diagnosed with a post-chemotherapy stricture and underwent progressive endoscopic balloon dilatation. He finally was scheduled for laparoscopic small bowel resection. An histological analysis of the surgical piece revealed a granulomatous reaction with multinucleated foreign body-like giant cells, without evidence of malignancy (recurrence of lymphoma) nor inflammatory infiltrate suggesting CD. The patient currently remains asymptomatic with no new episodes of abdominal pain.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Constriction, Pathologic
  • Crohn Disease* / complications
  • Crohn Disease* / drug therapy
  • Cyclophosphamide / therapeutic use
  • Doxorubicin / therapeutic use
  • Humans
  • Intestinal Obstruction / diagnostic imaging
  • Intestinal Obstruction / etiology
  • Jejunal Neoplasms* / complications
  • Jejunal Neoplasms* / diagnostic imaging
  • Male
  • Prednisone / therapeutic use
  • Rituximab / therapeutic use
  • Vincristine / therapeutic use

Substances

  • Doxorubicin
  • Cyclophosphamide
  • Vincristine
  • R-CHOP protocol
  • Prednisone
  • Rituximab