A SYSTEMIC DISEASE WITH GI PRESENTATION - A CASE REPORT

INTRODUCTION Apart from the many disorders that affect the GI tract primarily like achalsia , carcinomas infections, inflammatory bowel disease and so on the GI tract can be prominently involved in a host of systemic disorders like connective tissue disorders, scleroderma, henoch scholein purpura ,HIV, carcinoids etc. The early identification of these also aid in the diagnosis and subsequently leading on to appropriate treatment which may lead to substantial reduction in both morbidity and mortality as in our case below.CASE REPORT A 63 years old male presented with a 6 months history of early satiety, malaise, easy fatigability and significant weight loss. On examination he was found to be pale with generalised lymphadenopathy and hepatosplenomegaly. Upper and lower GI endoscopies were done which showed nodular lesions which were biopsied sent for HPE which showed small round cells with central nucleus and a rim of cytoplasm but was inconclusive. Imaging studies were done which showed a greatly thickened gastric wall, sigmoid colon and rectum along with free fluid in both peritoneal and pleural cavities. In view of the lyphadenopathy suggesting a systemic aetiology it was excised and sent for HPE which showed enlarged follicles with germinal centres and was suggested further staining studies. The slides were sent for immunohisto chemistry with CD 20 which turned out highly positive thus confirming the diagnosis of NON HODGKINS LYMPHOMA. A peripheral smear was done which also supported the diagnosis showing 85 blast cells suggesting a AML-M2 type blast transformation of the NHL. He was subsequently referred to the oncology department where he was started on R-CHOP regimen chemotherapy along with further sub typing follow up of NHL.