FATAL INTESTINAL HEMORRHAGE COMPLICATING ILEAL LYMPHOMA AFTER CYCLOSPORINE FOR UNRESPONSIVE CELIAC-DISEASE

Background/Aims: Unresponsive celiac disease may benefit from immunosu ppressive therapy, Malignant small intestinal lymphoma is the most ser ious complication of celiac disease, also being noted as a complicatio n of immunosuppressive therapy. The diagnosis of small intestinal lymp homa complicating celiac disease is notoriously difficult. Perforation is the most common complication of small intestinal lymphoma, frank h emorrhage being unusual. We report a case of massive, fatal hemorrhage from small intestinal lymphoma complicating unresponsive celiac disea se treated with cyclosporine. The patient was presented with severe di arrhea and nutritional deterioration. Unresponsive celiac disease was diagnosed on the basis of clinical and histologic criteria with no res ponse while on a gluten-free diet, corticotherapy and octreotide aceta te injections. Cyclosporine therapy was advised. The patient had a rem arkable clinical response. After 3 months from the start of the cyclos porine therapy, the patient returned with massive intestinal bleeding. The patient underwent emergency surgery diagnosing an enteropathy-ass ociated lymphoma. We conclude that cyclosporine therapy for unresponsi ve celiac disease should be considered in select, severely ill patient s only after a full-thickness biopsy of the small intestinal wall to d isclose a latent superimposed lymphoma, which course may be accelerate d by immunosuppressive therapy.