Enteropathy-associated T cell lymphoma as a complication of
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A 59-year-old female presented with weight loss, night sweats, and diarrhea since four months. Stool examination, serologic testing, esophagogastroduodenoscopy (EGD), colonoscopy (C-scope), and computed tomography (CT) scan of chest and abdomen were non-contributory. Diagnosed with celiac disease at 51, she had had no prior digestive symptoms despite poor adherence to a gluten-free diet and persistently positive anti-tissue transglutaminase antibodies. Physical examination revealed cachexia, widespread erythematous maculopapular skin lesions, and no palpable lymphadenopathy.

Laboratory examination showed hemoglobin 9.8 g/dL, mean cell volume 92 µm3, white blood cell count 5500/mL (lymphopenia at 300/µL), and serum albumin 2.2 g/dL. The PET scan showed intense FDG uptake in a left tonsillar mass with multiple FDG-avid subcutaneous lesions, and bowel and mesenteric involvement. Balloon enteroscopy revealed a mosaic form small bowel mucosa with multiple clean-based ulcers throughout the jejunum. Biopsies were consistent with the tonsillar findings. A few days following admission the patient underwent a laparotomy for small bowel perforation and was subsequently transferred to the intensive care unit where her course was complicated by recurrent gastrointestinal bleeding, septic shock, and respiratory failure, leading to death.

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