Zaheen Ahmad, Delabie Jan, Vajpeyi Rajkumar, Frost David W
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Pathology, University Health Network, Toronto, Ontario, Canada.
BMJ Case Rep. 2015 Nov 26;2015:bcr2015212103. doi: 10.1136/bcr-2015-212103.
A 74-year-old man presented with a 2-month history of watery diarrhoea. His complete blood count showed lymphopaenia and marked eosinophilia. Investigations for common infectious causes including Clostridium difficile toxin, stool culture, ova and parasites were negative. Endoscopy revealed extensive colitis and a CT of the abdomen identified numerous large abdominal lymph nodes suspicious for lymphoma. Multiple tissue samples were obtained; colon, mesenteric lymph node and bone marrow biopsy, as well as pleural fluid from a rapidly developing effusion, confirmed the presence of metastatic lymphoma with an immunophenotype most consistent with an aggressive variant of Epstein-Barr virus (EBV)-negative natural killer (NK)-cell lymphoma. The patient's clinical condition rapidly deteriorated and he died shortly following diagnosis. To the best of our knowledge, this is the first case report of a primary gastrointestinal EBV-negative NK-cell lymphoma, and its clinical presentation highlights the importance of a broad differential in the management of chronic diarrhoea.
一名74岁男性，有2个月的水样腹泻病史。他的全血细胞计数显示淋巴细胞减少和明显的嗜酸性粒细胞增多。对包括艰难梭菌毒素、粪便培养、虫卵和寄生虫在内的常见感染病因进行的检查均为阴性。内镜检查显示广泛的结肠炎，腹部CT发现多个大的腹部淋巴结，怀疑为淋巴瘤。获取了多个组织样本；结肠、肠系膜淋巴结和骨髓活检，以及快速形成的胸腔积液的胸水，证实存在转移性淋巴瘤，其免疫表型与爱泼斯坦-巴尔病毒（EBV）阴性自然杀伤（NK）细胞淋巴瘤的侵袭性变体最为一致。患者的临床状况迅速恶化，诊断后不久死亡。据我们所知，这是首例原发性胃肠道EBV阴性NK细胞淋巴瘤的病例报告，其临床表现凸显了在慢性腹泻管理中进行广泛鉴别诊断的重要性。
