1921
Volume 94, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Immunoproliferative small intestinal disease (IPSID) is an extra-nodal B-cell lymphoma most commonly described in the Mediterranean, Africa, and Asia. It is associated with poverty and poor sanitation, and is rarely encountered in developed countries. A 26-year-old previously healthy, Marshallese male was transferred to our facility with a 6-month history of watery diarrhea, weakness, and cachexia refractory to multiple short courses of oral antibiotics. Stool cultures grew and Endoscopic evaluation showed histologic evidence of gastritis and gross evidence of whipworm infection found in the colon. Mesenteric lymph node biopsy cultures grew Histopathology and immunohistochemical stains of the small intestine were consistent with IPSID. He subsequently transformed to diffuse large B-cell lymphoma (DLBCL) with tonsillar involvement despite treatment with rituximab and an extended course of antibiotics. Systemic chemotherapy with six cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone, and lenalidomide, resulted in remission of his diffuse B cell lymphoma. This case is illustrative of IPSID developing in a previously healthy individual due to overwhelming polymicrobial gastrointestinal infection by and other enteric pathogens with subsequent transformation to an aggressive DLBCL. IPSID should be considered in residents of developing countries presenting with refractory chronic diarrhea, weight loss, and mesenteric lymphadenopathy.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.15-0831
2016-05-04
2019-05-20
Loading full text...

Full text loading...

/deliver/fulltext/14761645/94/5/1177.html?itemId=/content/journals/10.4269/ajtmh.15-0831&mimeType=html&fmt=ahah

References

  1. Al-Saleem T, , 2005. Immunoproliferative small intestinal disease (IPSID): a model for mature B-cell neoplasms. Blood 105: 22742280.[Crossref] [Google Scholar]
  2. Lecuit M, Abachin E, Martin A, Poyart C, Pochart P, Suarez F, Bengoufa D, Feuillard J, Lavergne A, Gordon JI, Berche P, Guillevin L, Lortholary O, , 2004. Immunoproliferative small intestinal disease associated with Campylobacter jejuni . N Engl J Med 350: 239248.[Crossref] [Google Scholar]
  3. Mesnard B, De Vroey B, Maunoury V, Lecuit M, , 2012. Immunoproliferative small intestinal disease associated with Campylobacter jejuni . Dig Liver Dis 44: 799800.[Crossref] [Google Scholar]
  4. National Comprehensive Cancer Network, 2014. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Non-Hodgkin's Lymphoma (Version 5.2014). Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed November 1, 2015. [Google Scholar]
  5. Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, Müller-Hermelink HK, Campo E, Braziel RM, Jaffe ES, Pan Z, Farinha P, Smith LM, Falini B, Banham AH, Rosenwald A, Staudt LM, Connors JM, Armitage JO, Chan WC, , 2004. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 103: 275282.[Crossref] [Google Scholar]
  6. Nowakowski GS, LaPlant B, Macon WR, Reeder CB, Foran JM, Nelson GD, Thompson CA, Rivera CE, Inwards DJ, Micallef IN, Johnston PB, Porrata LF, Ansell SM, Gascoyne RD, Habermann TM, Witzig TE, , 2015. Lenalidomide combined with R-CHOP overcomes negative prognostic impact of non-germinal center B-cell phenotype in newly diagnosed diffuse large B-Cell lymphoma: a phase II study. J Clin Oncol 33: 251257.[Crossref] [Google Scholar]
  7. Fine KD, Stone MJ, , 1999. Alpha-heavy chain disease, Mediterranean lymphoma, and immunoproliferative small intestinal disease: a review of clinicopathological features, pathogenesis, and differential diagnosis. Am J Gastroenterol 94: 11391152. [Google Scholar]
  8. Rambaud JC, , 1983. Small intestinal lymphomas and alpha-chain disease. Clin Gastroenterol 12: 743766. [Google Scholar]
  9. Lankarani KB, Masoompour SM, Masoompour MB, Malekzadeh R, Tabei SZ, Haghshenas M, , 2005. Changing epidemiology of IPSID in southern Iran. Gut 54: 311312.[Crossref] [Google Scholar]
  10. Khojasteh A, Haghshenass M, Haghighi P, , 1983. Current concepts immunoproliferative small intestinal disease. A “Third-World lesion”. N Engl J Med 308: 14011405.[Crossref] [Google Scholar]
  11. Ersoy O, Akin E, Demirezer A, Atalay R, Buyukasik S, , 2012. Capsule-endoscopic findings in immunoproliferative small-intestinal disease. Endoscopy 44 (Suppl 2): E61E62. [Google Scholar]
  12. Ghoshal UC, Chetri K, Banerjee PK, Choudhuri G, Pal BB, Dabadghao S, Dhar K, Naik S, Naik SR, , 2001. Is immunoproliferative small intestinal disease uncommon in India? Trop Gastroenterol 22: 1417. [Google Scholar]
  13. Puri AS, Aggarwal R, Khan EM, Naik S, Ayyagari A, Pandey R, Naik SR, , 1992. Explosive Campylobacter jejuni diarrhea in immunoproliferative small intestinal disease. Indian J Gastroenterol 11: 141143. [Google Scholar]
  14. Coeuret S, de La Blanchardière A, Saguet-Rysanek V, Chèze S, Tavernier M, Arsène D, Criscuolo A, Brisse S, Vergnaud M, Verdon R, Lecuit M, , 2014. Campylobacter coli cultured from the stools of a patient with immunoproliferative small intestinal disease. Clin Microbiol Infect 20: 908911.[Crossref] [Google Scholar]
  15. Perlman DM, Ampel NM, Schifman RB, Cohn DL, Patton CM, Aguirre ML, Wang WL, Blaser MJ, , 1988. Persistent Campylobacter jejuni infections in patients infected with the human immunodeficiency virus (HIV). Ann Intern Med 108: 540546.[Crossref] [Google Scholar]
  16. Bodhidatta L, McDaniel P, Sornsakrin S, Srijan A, Serichantalergs O, Mason CJ, , 2010. Case-control study of diarrheal disease etiology in a remote rural area in western Thailand. Am J Trop Med Hyg 83: 11061109.[Crossref] [Google Scholar]
  17. Dutta U, Udawat H, Noor MT, Sidhu GS, Kochhar R, Vaiphei K, Singh K, , 2010. Regression of immunoproliferative small intestinal disease after eradication of Helicobacter pylori . J Gastrointest Cancer 41: 212215.[Crossref] [Google Scholar]
  18. Fischbach W, Tacke W, Greiner A, Konrad H, Müller-Hermelink HK, , 1997. Regression of immunoproliferative small intestinal disease after eradication of Helicobacter pylori . Lancet 349: 3132.[Crossref] [Google Scholar]
  19. Matsumoto S, Kinoshita Y, Fukuda H, Waki S, Asahara M, Matsushima Y, Kawanami C, Fujimori T, Chiba T, , 1996. “Mediterranean lymphoma” treated with antibiotics. Intern Med 35: 961965.[Crossref] [Google Scholar]
  20. Saghir el NS, , 1995. Combination chemotherapy with tetracycline and aggressive supportive care for immunoproliferative small-intestinal disease lymphoma. J Clin Oncol 13: 794795.[Crossref] [Google Scholar]
  21. Foster LH, Portell CA, , 2015. The role of infectious agents, antibiotics, and antiviral therapy in the treatment of extranodal marginal zone lymphoma and other low-grade lymphomas. Curr Treat Options Oncol 16: 28.[Crossref] [Google Scholar]
  22. Pervez S, Mumtaz K, Ullah SS, Akhtar N, Ali N, Aaqil H, , 2011. Immunoproliferative small intestinal disease (IPSID). J Coll Physicians Surg Pak 21: 5758. [Google Scholar]
  23. Stratigos P, Kouskos E, Kouroglou M, Chrisafis I, Fois L, Mavrogiorgis A, Axiotis E, Zamtrakis S, , 2007. Emergency pancreatoduodenectomy (whipple procedure) for massive upper gastrointestinal bleeding caused by a diffuse B-cell lymphoma of the duodenum: report of a case. Surg Today 37: 680684.[Crossref] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.15-0831
Loading
/content/journals/10.4269/ajtmh.15-0831
Loading

Data & Media loading...

  • Received : 18 Nov 2015
  • Accepted : 13 Jan 2016
  • Published online : 04 May 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error