T-Cell lymphoma misdiagnosed as Crohn's disease: Case report

For many years, there has been a concern that inflammatory bowel disease carries an increased lymphoma risk. At the same time, patients with intestinal lymphomas are occasionally misdiagnosed as having Crohn's disease. We report a case of T-cell lymphoma of the bowel misdiagnosed as Crohn's disease, which illustrates the diagnostic challenges posed by peripheral extranodal lymphomas. A 68-year old female presented with clinical symptoms (diarrhoea, abdominal pain, poor appetite and significant weight loss), and colonoscopic and initial histological findings that were similar to inflammatory bowel disease. She was diagnosed with Crohn's disease and received treatment with sulfasalazine with subsequent improvement of symptoms. Eight months after the initial diagnosis the patient experienced sudden abdominal pain. Laparotomy revealed necrosis in the small and large intestine and ileostomy was performed. On day 10 of a complicated postoperative period the patient died. Post-mortem histopathological examination of small and large intestine revealed highly malignant peripheral T-cell lymphoma, not otherwise specified. Differentiation of intestinal T-cell lymphoma from Crohn's disease continues to be a challenge, because clinical, colonoscopic, radiological and histopathological findings can mimic Crohn's disease. Careful multi-disciplinary assessment and knowledge of this rare disorder is crucial for timely diagnosis.