Muslim Atiq, Muzzaffar Lateef Gill, Nasir Khokhar, Javed Aslam Butt.
Intestinal non-hodgkin`s lymphoma presenting with sub acute abdomen: A report of two cases.
Rawal Med J Jan ;28(2):77-9.

A 26 years old male presented to Shifa International Hospital with fever and abdominal pain of one and a half month’s duration. Fever was initially low grade but then started spiking at 1030F. Abdominal pain was more marked in the right lower abdomen. He also reported a weight loss of 10-12 kg over the past 6 months. He was diagnosed as intestinal TB elsewhere and was on ATT for one month. However, there was no improvement in his symptoms. On examination, he was a young pale looking man in obvious distress with a pulse of 110 and a fever of 1000F. There was no lymphadenopathy. Abdominal examination revealed a mass around 5cm in the right iliac fossa. However, there was no liver or spleen enlargement on palpation. Laboratory data included a hemoglobin of 7.8 g/dl, a white blood cells (WBC) count of 10,700 /uL, with 88% neutrophils and 10% lymphocytes. Erythrocyte sedimentation rate (ESR) was 137 mm/hr. Liver enzymes were in the normal range whereas there was an elevated prothrombin time with an INR of 1.8. A bone marrow aspiration biopsy was performed which showed normocellular marrow with no evidence of lymphoma cells. Chest x-ray was normal. Computed tomography scan showed enlarged liver with marked thickening of antral part of the stomach, thickening of 1st and 3rd part of duodenum, cecum and ascending colon along with multiple lymph nodes in the para aortic region. Mini-laparotomy was performed and lymph nodes were excised from the right iliac fossa. Histopathology revealed NHL. He was started on CHOPP regimen.

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