Russell Body Duodenitis

Abstract

Purpose: Russell body gastritis (RBG) is an uncommon, yet well reported entity that is often associated with Helicobacter pylori (H. pylori) infection. RBG has been described in patients with alcohol abuse and human immunodeficiency virus (HIV) infection. We report a case of Russell body duodenitis (RBD) in an HIV positive patient without evidence of H. pylori infection. In our review of the literature, no cases of RBD have been reported to date. Methods: A 55-year-old HIV positive male presented with abdominal pain. An esophagogastroduodenoscopy (EGD) was performed and biopsies of the stomach and duodenum were taken. Hematoxylin and eosin (H&E) stained slides as well as immunohistochemical stains were reviewed and a literature search was performed. Results: The EGD revealed non-specific gastritis and duodenitis without an identifiable mass. H&E stained slides from the duodenum showed a dense infiltrate of plasma cells with numerous Russell bodies (Figure 1). No discernable microorganisms, lymphoepithelial lesions, or neoplastic cells were identified. CD138 highlighted the numerous plasma cells and kappa and lambda immunohistochemical stains revealed a polytypic pattern. The gastric biopsies only showed chemical gastritis and were negative for H. pylori. Conclusion: This is the first reported case of Russell body duodenitis. This benign lesion may be mistaken for a neoplastic process such as plasmacytoma, lymphoma, or signet ring cell carcinoma so it is important for pathologists to be aware of this condition. The absence of H. pylori infection and location in the duodenum are unique findings in our case. Plasma cell proliferations are not uncommon in the lymph node and bone marrow of HIV positive patients; RBD may represent a similar process.Figure