S6359 Incidental Finding of Diffuse Large B-Cell Lymphoma With Gastric Metastasis in the Setting of Recent EBV Infection

Introduction: Lymphoma is a malignancy of lymphocytes including T cells, B cells and natural killer (NK) cells. Diffuse large B cell lymphoma (DLBCL) is part of the non-Hodgkin lymphoma subtype. These malignancies spread hematogenously which is why they are typically discovered incidentally as advanced masses or enlarging lymph nodes. The gastrointestinal tract is the most common primary location of extra-nodal involvement of DLBCL. Here we present the case of a 72-year-old woman with a recent Epstein Barr Virus (EBV) infection that presented with upper GI bleeding and was found to have multiple ulcerated nodules in the gastric fundus and body with pathology review confirming DLBCL. Case Description/Methods: A 72-year-old woman with a past medical history of gastroesophageal reflux disease and chronic kidney disease presented to the emergency department for hematemesis. She reported painful lymph nodes in her neck as well as unintentional weight loss for 3 months. She had been diagnosed with a recent Epstein Barr virus infection 3 months prior to admission. Initial laboratory findings were significant for a hemoglobin 6.3. A computed tomography (CT) of the abdomen as well as a CT of the neck revealed diffuse cervical and axillary lymphadenopathy with splenomegaly. The Gastroenterology service was consulted and performed an Esophagogastroduodenoscopy (EGD) which revealed multiple ulcerated nodular lesions in the gastric fundus and body. Biopsies resulted positive for diffuse large B cell lymphoma (DLBCL). A lymph node and bone marrow biopsy were performed which confirmed the diagnosis of DLBCL. Oncology was consulted and promptly initiated chemotherapy. She was subsequently hospitalized multiple times, eventually requiring mechanical ventilation for an acute coronavirus disease 2019 infection. The family decision was made to transition to comfort care and she shortly passed away. Discussion: Diffuse large B cell lymphoma (DLBCL) is a primarily aggressive type of lymphoma. It is often discovered incidentally at an advanced stage. A particularly rare subtype of DLBCL is EBV-positive DLBCL, which is more common in immunocompromised patients, such as those with HIV or a history of organ transplantation. Our patient tested positive for a recent or reactivated EBV infection approximately 3 months prior to her diagnosis of DLBCL. Immunoglobulin G levels of EBV can remain elevated for an individual's lifetime; however, it should be noted that elevated IGg levels of EBV in the setting of a new diagnosis of DLBCL should raise clinical suspicion for an aggressive subset of lymphoma.