Krishnamurthy Nithya, Petersen Bruce, Farag Christian, Hafez Anthony, Kulkarni Raksha, Cangut Busra, Asrani Roshan
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus. 2025 Jul 5;17(7):e87342. doi: 10.7759/cureus.87342. eCollection 2025 Jul.
We present the case of a 60-year-old Caribbean man with no significant past medical history who presented to the emergency department with a three-week history of progressive, diffuse abdominal pain associated with early satiety and unintentional weight loss. Vital signs were stable, and physical examination revealed abdominal distension and diffuse tenderness without peritoneal signs. Laboratory studies were notable for elevated lactate dehydrogenase and mild leukocytosis. Computed tomography followed by PET-CT imaging demonstrated multiple nodular soft tissue densities with increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake throughout the mesentery, peritoneum, and bilateral pleural surfaces, raising concern for peritoneal lymphomatosis. An ultrasound-guided biopsy of an omental implant was performed, revealing large atypical lymphoid cells positive for CD3, CD2, and CD4, and negative for CD5, CD7, and CD8, with a Ki-67 proliferation index of 90%, consistent with an aggressive peripheral T-cell lymphoma. Peripheral blood RT-PCR returned positive for human T-cell lymphotropic virus type 1 (HTLV-1), aligning with the diagnosis of acute adult T-cell leukemia/lymphoma (ATLL), stage IV. The patient's clinical course was rapidly progressive and marked by complications including spontaneous tumor lysis syndrome, recurrent episodes of malignant small bowel obstruction, and gram-negative bacteremia. While preparing for treatment with dose-adjusted etoposide phosphate, vincristine sulfate (Oncovin), cyclophosphamide, and doxorubicin hydrochloride (hydroxydaunomycin) (EPOCH) chemotherapy, he suffered a cardiac arrest during central venous catheter placement. Despite resuscitation efforts, he sustained an anoxic brain injury and died 32 days after the initial presentation. This case highlights an aggressive presentation of ATLL with peritoneal involvement and underscores the challenges of rapid disease progression and acute complications, as well as the importance of considering endemic exposure history, utilizing PET-CT for identifying extranodal disease, and rapidly confirming diagnosis through biopsy.
我们报告一例60岁的加勒比男性病例，其既往无重大病史，因进行性弥漫性腹痛3周伴早饱及非故意体重减轻就诊于急诊科。生命体征稳定，体格检查发现腹部膨隆及弥漫性压痛，但无腹膜刺激征。实验室检查显示乳酸脱氢酶升高及轻度白细胞增多。计算机断层扫描及随后的PET-CT成像显示肠系膜、腹膜及双侧胸膜表面有多个结节状软组织密度影，氟-18氟脱氧葡萄糖（18F-FDG）摄取增加，提示腹膜淋巴瘤。对网膜植入物进行超声引导下活检，结果显示大型非典型淋巴细胞CD3、CD2和CD4阳性，CD5、CD7和CD8阴性，Ki-67增殖指数为90%，符合侵袭性外周T细胞淋巴瘤。外周血逆转录聚合酶链反应检测显示人类嗜T淋巴细胞病毒1型（HTLV-1）阳性，符合急性成人T细胞白血病/淋巴瘤（ATLL）IV期诊断。患者临床病程进展迅速，出现包括自发性肿瘤溶解综合征、恶性小肠梗阻反复发作及革兰阴性菌血症等并发症。在准备接受剂量调整的磷酸依托泊苷、硫酸长春新碱（Oncovin）、环磷酰胺和盐酸多柔比星（羟基柔红霉素）（EPOCH）化疗时，他在中心静脉导管置入过程中发生心脏骤停。尽管进行了复苏努力，但他仍遭受缺氧性脑损伤，并在首次就诊后32天死亡。该病例突出了ATLL伴腹膜受累的侵袭性表现，强调了疾病快速进展和急性并发症的挑战，以及考虑地方暴露史、利用PET-CT识别结外疾病及通过活检快速确诊的重要性。
