Immunoproliferative small intestinal disease presenting as gastrointestinal bleed

Immunoproliferative small intestinal disease (IPSID) also called “Mediterranean lymphoma”, is a rare variant of mucosa-associated lymphoid tissue (MALT) lymphomas mainly involving the proximal small intestine. IPSID typically presents with nonspecific GI symptoms including chronic diarrhea, weight loss and malabsorption which typically delay diagnosis. This entity rarely presents as gastrointestinal (GI) bleed; we report a rare case of IPSID presenting as iron deficiency anemia and melena as a consequence of bleeding from the small intestine which was eventually diagnosed on capsule endoscopy after normal initial gastroscopy and colonoscopy. The patient received six courses of chemotherapy with a combination of rituximab and bendamustine, with good outcomes at 6 months post therapy completion. • Immunoproliferative small intestinal disease (IPSID) also called “Mediterranean lymphoma”, is a • rare variant of MALT lymphomas mainly involving the proximal small intestine. • IPSID typically presents with nonspecific GI symptoms including chronic diarrhea, weight loss • and malabsorption which typically delay diagnosis. This entity rarely presents as gastrointestinal • (GI) bleed. • This case report aims to elucidate the clinical course, diagnostic approach, and management • strategies for a patient who presented with GI bleed secondary to IPSID, highlighting the • importance of early recognition and intervention in such complex cases.