A 25 Years Old Male with Primary Duodenal Lymphoma

Primary duodenal lymphoma is very atypical, although the gastrointestinal (GI) tract is the most prominent site of extra nodal lymphoma. Here we present a case of 25 years old male, presented with upper abdominal pain and vomiting and eventually diagnosed as a case of duodenal non Hodgkin’s lymphoma. The particular interest in this report is the fact that, it is important to have a high index of suspicion to diagnose primary intestinal lymphoma as it has high mortality which requires early diagnosis and treatment. 1. Assistant Professor, Department of Medicine, Dhaka Medical College, Dhaka 2. Associate professor, Department of Medicine, Dhaka Medical College, Dhaka 3. Post-graduate Trainee, Dept. of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka 4. Post-graduate Trainee, Dept. of Medicine, Dhaka Medical College Hospital, Dhaka Correspondence : Dr. Ahmedul Kabir, Assistant Professor, Department of Medicine, Dhaka Medical College, Dhaka with local gastrointestinal symptoms, which includes malabsorption, mass lesions, bowel obstruction, bleeding, and/or systemic symptoms like fever, weight loss and night sweats.1 We are reporting a patient who presented to our institution with acute abdomen and diagnosed as primary Non Hodgkin’s Lymphoma (NHL) of the gastrointestinal tract. Case report A 25 years old, previously healthy male, presented to us with upper abdominal pain and vomiting for two months. The pain was located in the epigastric region, colicky in nature and radiating towards the back associated with vomiting of ingested food material. There were no systemic symptoms and his bowel and bladder habit were normal. On examination he was hemodynamically stable with mild anaemia and no lymphadenopathy. Per abdominal examination reveals slightly distended abdomen with rigid abdominal wall. There was mild tenderness in the epigastric region and bowel sound was sluggish. Other systemic examination were normal. On investigation, Complete blood count and Blood film revels, WBC 14.5 X 10x9 /L with a PMN predominance of 74%, Hematocrit – 39.28%, Platelets – 250 X 10x9 /L, ESR – 20 mm/1st Hr, Hb ( Cyn. Meth. ) – 13.5 g/dl ( normal is 13-17 g/dl ), PBF : RBC – Normocytic and normochromic , WBC – Mature with Neutrophil Leukocytosis , Plateletes – Normal. Urinalysis was negative for protein or red cells. Blood C a J MEDICINE 2009; 10 : 124-127