Small bowel T-cell lymphoma with perforation in the HIV/AIDS context, a rare case report

Introduction and Importance.

Small bowel lymphomas, which represent <1 % of gastrointestinal cancers, are most found in the ileum due to its high concentration of gut-associated lymphoid tissue. T-cell lymphomas of the small bowel are particularly rare. While increased risk is noted in conditions like celiac disease and immunodeficiency, their occurrence in HIV/AIDS patients is uncommon and poorly understood. The rare complication of gastrointestinal perforation in these cases complicates diagnosis and management.

Case presentation

42-year-old woman with HIV/AIDS, on antiretroviral therapy for 4 years, presented with a 1-month history of progressively worsening abdominal pain, intermittent fevers, weight loss, and a productive cough. On physical examination, she was cachectic, febrile, and had generalized abdominal tenderness with signs of peritonism. Laboratory investigations revealed anemia, elevated CRP, and ESR, with a CD4 count of 441 cells/mcL. Imaging studies, including abdominal CT, showed free air and fluid suggestive of a perforated viscus. The patient underwent emergency laparotomy, which revealed multiple bowel perforations. Resection was performed, and histopathology confirmed small bowel T-cell lymphoma (anaplastic large cell lymphoma). Despite intensive postoperative care, the patient died on the fourth postoperative day.

Clinical discussion

Small bowel T-cell lymphoma is rare, especially in HIV/AIDS patients, and poses significant diagnostic challenges. Its presentation is often nonspecific, and perforation is a serious complication. While chemotherapy and surgery are key treatments, T-cell lymphomas are more resistant to therapy, leading to a poor prognosis, particularly when complicated by perforation.

Conclusion

This case highlights the rarity and complexity of small bowel T-cell lymphoma in HIV/AIDS, compounded by gastrointestinal perforation. Early diagnosis, advanced imaging, and multidisciplinary management are essential for improving outcomes. Further research is needed to optimize treatment strategies for this challenging case.