Ladna Michael, George John, Forsmark Christopher E
Internal Medicine, University of Florida College of Medicine, Gainesville, USA.
Gastroenterology, University of Florida College of Medicine, Gainesville, USA.
Cureus. 2024 Feb 20;16(2):e54555. doi: 10.7759/cureus.54555. eCollection 2024 Feb.
A patient status post (s/p) renal transplantation in 2014 presented with an upper gastrointestinal bleed (UGIB). The source of the bleed was found to be a large mass in the duodenum with histopathology from biopsies obtained during esophagogastroduodenoscopy revealing diffuse large B-cell lymphoma (DLBCL) of the duodenum. His mycophenolate was stopped, and the tacrolimus dose was reduced due to active malignancy. He was discharged and completed one cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) before presenting back to ED with hemorrhagic shock from a large upper GI bleed requiring admission to the medical intensive care unit. Post-transplant lymphoproliferative disorders such as DBLCL can present 10 years from the transplant date. These malignancies are at high risk for bleed, especially after treatment with chemotherapy is initiated.
一名于2014年接受肾移植术后的患者出现上消化道出血（UGIB）。出血源被发现是十二指肠内的一个大肿块，经食管胃十二指肠镜检查期间获取的活检组织病理学检查显示为十二指肠弥漫性大B细胞淋巴瘤（DLBCL）。由于存在活动性恶性肿瘤，停用了他的霉酚酸酯，并降低了他克莫司的剂量。他出院了，并在因大量上消化道出血导致失血性休克返回急诊科之前完成了一个周期的R-CHOP（利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松）治疗，该出血需要入住医学重症监护病房。移植后淋巴组织增生性疾病，如DBLCL，可在移植日期起10年后出现。这些恶性肿瘤有很高的出血风险，尤其是在开始化疗后。
