Spontaneous Multiperforation in Lymphomatous Colitis Masquerading as Crohnʼs Disease: Two Cases

Abstract

Purpose: Lymphomatous colitis is a rare disorder that can simulate inflammatory bowel disease. We describe 2 cases of lymphomatous colitis mimicking Crohn's disease that were complicated by spontaneous multiperforation. Case 1: An 82 year old female with a history of chronic lymphocytic leukemia presented with progressive diarrhea over 5 months, associated with a 20 pound weight loss. Colonoscopy showed moderately severe pancolitis with ileal inflammation. Biopsies were reported as inflammatory colitis. She failed to respond to high dose corticosteroids. Within 4 weeks she required emergent colectomy for spontaneous multiperforation of her colon. Pathology revealed colonic and ileal MALT lymphoma. The colonic lymphoma was distinct from her chronic lymphocytic leukemia, since the former was negative to CD5 and did not have chromosomal trisomy 12, whereas the latter was CD5 positive and positive for trisomy 12. This indicates that the patient had 2 distinct lymphoproliferative diseases. In retrospect, immunoperoxidase stains on the initial biopsies did reveal malignant monoclonal lymphocytes. (See Table) Case 2: A 49 year old female with a history of ulcerative colitis presented with severe watery diarrhea and a 50 pound weight loss. Colonoscopy revealed severe pancolitis with skip areas of normal colon. Biopsies were reported as inflammatory colitis. She failed to respond to high dose corticosteroids, and refused surgery. Within a number of weeks, she required emergent colectomy for spontaneous multiperforation of her colon. Pathology revealed primary colonic non-hodgkins lymphoma (NHL). In retrospect, immunoperoxidase stains on the initial biopsies did reveal malignant monoclonal lymphocytes. (See Table) Conclusion: Lymphomatous colitis can mimick Crohn's colitis. Lymphomatous colitis should be considered in patients with steroid-refractory inflammatory bowel disease. Earlier diagnosis with immunoperoxidase stains looking for monoclonal proliferation of malignant lymphocytes, may prevent progression of necrotizing lymphoma and spontaneous multiperforation.Table: Lymphomatous Colitis: 2 cases