Relapsed Angioimmunoblastic T-Cell Lymphoma Presenting as Severe Colitis With Bowel Perforation: 1505

INTRODUCTION: Angioimmunoblastic T-cell lymphoma (AITL) is a subtype of the uncommon peripheral T-cell lymphomas that usually presents as acute onset of systemic B symptoms and generalized lymphadenopathy. Here, we report a case of a woman with relapsed AITL involving the descending, sigmoid colon, and rectum, presenting as persistent diarrhea and bowel perforation. CASE DESCRIPTION/METHODS: A 78-year-old woman who was diagnosed with AITL in 2002 and had been stable on continuous therapy of romidepsin for the past 2.5 years for relapsed disease, presented with a 6-week history of diarrhea, fatigue, and decreased appetite. The diarrhea was watery, non-bloody, occurred 4-5 times a day, with fecal urgency and incontinence. The patient denied any abdominal pain, nausea, vomiting, or fever. There was no recent change in her medications, and no recent history of travel or contact with children or pets. During the 6-week period, she was hospitalized twice and was initially thought to have infectious colitis, for which she was given ciprofloxacin, metronidazole, and re-hydration therapy. Abdominal CT showed severe left-sided colitis with multiple enlarged perirectal and mesenteric lymph nodes. Upon her third admission, infectious etiologies were ruled-out and sigmoidoscopy showed markedly edematous and erythematous rectum. Biopsies from the rectum and sigmoid colon showed dense atypical T-cell infiltration consistent with involvement of her previous AITL. Her hospital course was further complicated by bowel perforation and polymicrobial positive blood cultures. She refused surgery and was referred to home hospice for palliative care. DISCUSSION: AITL is an aggressive peripheral T-cell lymphoma that is believed to arise from CD4 positive follicular helper T-cells. It accounts for 1-2% of non-Hodgkin lymphoma cases and has a higher incidence among Asian/Pacific Islanders and Hispanic Whites in the United States. Initial presentation commonly includes generalized lymphadenopathy, fever, unintentional weight loss, and night sweats. With progression, it can commonly involve the bone marrow, spleen, skin and soft tissues. However, gastrointestinal involvement is rare. In 1996, Goenka et al. reported AITL presenting as colonic polyps. We are reporting a case of AITL progressing to involve the descending, sigmoid colon, and rectum, whose presentation was initially mistaken for infectious colitis. However, due to high clinical suspicion, sigmoidoscopy was performed and biopsies confirmed the diagnosis of AITL of the colon.