Immunoblastic lymphadenopathy-like T-cell lymphoma complicated by multiplegastrointestinal involvement

We report a rare case of immunoblastic lymphadenopathy (IBL)-like T-cell ly mphoma complicated by multiple gastrointestinal involvement, which appeared to be ameliorated by chemotherapy but resulted in perforative peritonitis. A 66-year-old Japanese woman who had generalized lymphadenopathy and erupt ions was admitted to our hospital because of bloody stool. Colonoscopic exa mination revealed hemorrhagic ulcers in the terminal ileum and a saucer-lik e ulcer in the cecum. Gastrointestinal endoscopy revealed several ulcerativ e or elevated lesions in stomach and duodenum. Biopsy specimens of these le sions and of a lymph node showed characteristic histological features of IB L-like T-cell lymphoma. The initial treatment with prednisolone (PSL) and c yclophosphamide (CPA) was effective. Six months after the treatment, howeve r, she developed bloody stool again caused by multiple ulcerative lesions i n the large intestine. The recurrence of the disease was determined histolo gically, and four courses of CPA, PSL, vinblastine sulfate and doxorubicin hydrochloride (CHOP) therapy were administered. One month after completing the CHOP therapy, she developed intestinal obstruction and then acute perit onitis resulting from perforation at an ulcer scar in the jejunum. Surgical treatment was successful, and histological examination demonstrated no lym phoma cells in the resected specimen, A gastrointestinal perforation should be recognized as a potential complication of IBL-like T-cell lymphoma, eve n during remission.