Intravascular large B-cell lymphoma with acute abdomen as a presenting symptom in a patient with systemic lupus erythematosus.

摘要

A 63-year-old woman with a 14-year history of systemic lupus erythematosus (SLE) presented with severe lower abdominal pain and hematochezia on the morning of May 4, 2006, and she was admitted to our hospital that night. She had been receiving treatment with pr ednisolone at 11 mg/d. On physical examination, lymph-adenopathy, skin rash, and arthritis were not noted. The abdomen had hypogastric tenderness to palpation without peritoneal signs. WBC count, C-reactive protein, and lactate dehydrogenase (LDH) were elevated at 12,200/muL (normal: 4,000 to 9,000/muL), 2.35 mg/mL (normal: 0 to 0.2 mg/dL), and 555 U/L (normal: 124-232 U/L), respectively Other laboratory values were within normal limits. Abdominal x-ray revealed gas in the small intestine. The patient had a nasogastric tube put in place and was forbidden to eat Because she showed peritoneal signs on the morning of May 5, abdominal computed tomography (CT) was done immediately and revealed enlargement of the small intestine (Fig 1A, arrow) and superior mesenteric vein thrombosis (Fig IB, arrow).