T-Cell lymphomas presenting as multiple colon ulcers and panniculitis: A case report

Introduction: Primary colon T-cell lymphoma is an uncommon entity that may mimic Inflammatory Bowel Disease (IBD). The differential diagnosis of gastrointestinal malignant lymphoma must be considered when clinically diagnosed IBD is refractory to the medical treatment clinical behavior and the apperance of more symtoms. Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is also a rare cytotoxic T-cell lymphoma. Case presentation: The current study presents a rare case of primary colon T-cell lymphoma in a 31-year-old female with marked recent weight loss, fever, watery diarrhea and panniculitis of forearm and thigh, who received a laboratory checkup and endoscopic workup for colon biopsy. The initial pathological report was consistent with mucosal inflammation and benign colon ulcers. A biopsy of the panniculitis of forearm and thigh suspected T-cell lymphoma. Additional immunohistochemical stains were used accordingly, which showed positive results for CD3,CD4,CD8 antibodies confirming the diagnosis of lymphoma. That led to a review of colonoscopy done approximately 2 week after the previous exammination. However, all colon ulcers suprisingly disappeared that led to diagnosis “wax and wane”ulcers. Then this patient was treated with CHOPE chemotherapy and had good response. Conclusion: The endoscopic diagnosis of ulcerative colon T-cell lymphoma is frequently confused with inflammatory conditions of the large bowel such as IBD, and tuberculosis colitis. This case emphasizes the importance role of detail physical examination and endoscopy with biopsy in diagnosing rare diseases. Lymphoma should be suspected in colorectal lesions with systemic symptoms. Panniculitis can be also an indicator for a systemic diseases such as lymphoma.