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A 67-year-old man presented with a 3-day history of abdominal pain, fever, and significant weight loss over 2 months. Physical examination revealed left upper quadrant tenderness, hepatomegaly, splenomegaly, and bilateral pitting edema but peripheral lymphadenopathy was absent. Laboratory tests showed anemia, thrombocytopenia, elevated prothrombin time (PT), partial thromboplastin time (PTT), and increased lactate dehydrogenase (LDH). PTT was corrected completely in mixing study. Further workup for the cause of coagulopathy revealed decreased levels of all clotting factors except factor VIII and increase fibrinogen levels, which ruled out disseminated intravascular coagulation (DIC). Flow cytometry of peripheral blood was normal. Contrast-enhanced computed tomography (CECT) revealed splenomegaly with multiple splenic infarcts without any mediastinal or intraabdominal lymphadenopathy. Further investigations for infective endocarditis (blood cultures and transthoracic echocardiography) and autoimmune disorders (ANA, dsDNA, RA factors) were negative. The patient received treatment for sepsis empirically without any significant clinical improvement. The diagnosis remained unclear despite extensive workup and liver biopsy was conducted due to high suspicion of granulomatous diseases. However, the liver biopsy revealed high-grade diffuse large B-cell lymphoma (DLBCL). Unfortunately, patient died shortly after the diagnosis. Here we report a case of high-grade DLBCL with hepatosplenomegaly and splenic infarcts in the absence of any lymphadenopathy or focal lesions. This case highlights the fact that unusually lymphoma can present in the absence of lymphadenopathy or mass lesion mimicking autoimmune and granulomatous disorders. The diagnosis in these cases can only be made on histology, and hence the threshold for biopsy should be low in patients with unclear presentations and multiorgan involvement.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298475 | PMC |
http://dx.doi.org/10.1177/2324709617690748 | DOI Listing |
Int J Surg Case Rep
December 2024
Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China. Electronic address:
Introduction: Splenic infarction caused by thrombi rarely causes abdominal pain in acute abdomen patients. This report describes a case of splenic infarction caused by thrombus detachment due to paroxysmal atrial fibrillation, which was successfully treated and discharged from the hospital.
Case Presentation: A 52-year-old woman walked into the emergency room with left upper abdominal pain, nausea, and vomiting 12 h prior.
BMC Infect Dis
December 2024
The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei Province, 443000, China.
Background: Yersinia pseudotuberculosis is an emerging zoonotic intestinal pathogen primarily transmitted through contaminated food and water. Infections caused by Yersinia pseudotuberculosis are typically self-limiting, often presenting as gastroenteritis or "pseudoappendicitis," which is characterized by fever and abdominal pain. Although bloodstream infections with Yersinia pseudotuberculosis are rare, they can lead to multiple distant sites of infection, including abscesses in the liver, spleen, and kidneys, as well as in the hip and knee joints, particularly in individuals with underlying immunodeficiency.
View Article and Find Full Text PDFJ Clin Med
November 2024
Medical Imaging Department, Henri Mondor University Hospital Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
High-flow pancreaticoduodenal artery (PDA) aneurysms secondary to celiac trunk occlusion or stenosis have a high risk of rupture. Embolization offers a less invasive alternative to surgery. We evaluated the effectiveness and safety of retrograde embolization via the superior mesenteric artery of high-flow PDA aneurysms without celiac trunk revascularization.
View Article and Find Full Text PDFJ Surg Case Rep
December 2024
Department of Radiology, Rafedia Hospital, Rafidia Main Street, Nablus, Palestine.
Dieulafoy lesions are a rare cause of gastrointestinal bleeding, characterized by an enlarged submucosal blood vessel that bleeds without visible abnormalities. The diagnosis is typically made via endoscopy, and treatment usually involves endoscopic therapy. This case involves a 46-year-old female who presented with upper gastrointestinal bleeding due to a Dieulafoy's lesion, treated with band ligation and later embolization after the lesion was found to originate from the left phrenic artery.
View Article and Find Full Text PDFCureus
November 2024
Infectious Diseases, Southern Illinois University School of Medicine, Springfield, USA.
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