Acquired immunodeficiency syndrome, Crohn's disease and lymphoproliferative disorder: a complicated trinomial for a correct diagnosis

This case report describes a 35-year-old woman who accessed the Emergency Department of Bergamo EST Hospital with asthenia, persistent fever up to 40 °C, weight loss, and proctorrhagia. Clinical examination revealed lower extremity ecchymoses, jaundiced sclera, and tachycardia. Blood tests showed severe macrocytic anemia, thrombocytopenia, plasma cells, and atypical apoptotic lymphocytes. HIV testing was positive (310,000 copies/mL) with a TCD4+ count of 258 cells/mm3. Serum protein electrophoresis revealed a monoclonal IgM-kappa component, suggesting a lymphoproliferative disorder. A computed tomography scan of abdomen showed rectal thickening and intra-abdominal lymphadenopathy, raising suspicion of Crohn’s disease. This case highlights the need for a multidisciplinary approach, integrating laboratory and clinical expertise to devise an optimal treatment strategy for complex comorbidities such as HIV, lymphoproliferative disorder, and inflammatory bowel disease. Further research is required to establish clearer guidelines for managing such challenging cases.