The authors report a rare case of acute onset of ileal non-Hodgkin's lymphoma with acute abdomen due to bowel perforation. The patient, a man aged 36 years, had been HIV-positive for more than 15 years. The patient had been on continuous, differentiated pharmacological treatment for the previous 5 years, and in the last month had had repeated episodes of fever with no clear aetiopathogenesis. Physical examination yielded negative findings and abdominal and chest CT failed to reveal any obvious lesions. The patient was admitted as an emergency case with a picture of acute abdomen and was immediately operated on; ileal perforation due to multiple lymphomatous lesions in the small bowel was diagnosed. The histological diagnosis was large-cell non-Hodgkin's lymphoma type B. After the operation, the patient was treated by chemotherapy and, currently, after a 12-month follow-up, is in good general condition.

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