A Giant Intra-Abdominal Plasmablastic Neoplasm Favoring Lymphoma Mimicking an Exacerbation of Severe Fistulizing Crohn's Disease: A Case Report.
- 1Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland.
- 2Department of Surgical Medicine, Faculty of Medicine, Jan Kochanowski University in Kielce, Kielce, Poland.
- 3Department of General, Oncological and Endocrine Surgery, Provincial Integrated Hospital, Kielce, Poland.
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a rare, aggressive large B-cell lymphoma associated with immunosuppression. In Crohn's disease, it can mimic disease exacerbation or infection. We describe a rapidly enlarging intra-abdominal plasmablastic neoplasm in a medically complex patient, emphasizing diagnostic vigilance without inferring a causal association with biological therapy. CASE REPORT A 44-year-old woman with severe fistulizing Crohn's disease treated sequentially with adalimumab, infliximab, and ustekinumab developed progressive systemic deterioration despite partial intestinal stabilization. Her course included portal hypertension secondary to portal vein thrombosis, refractory ascites, severe malnutrition, and recurrent systemic and multidrug-resistant infections. In September 2023 imaging showed a rapidly enlarging intra-abdominal/pelvic mass measuring more than 22 cm. Core-needle biopsy demonstrated a plasmablastic neoplasm positive for CD38, CD138, MUM1, and c-MYC, with equivocal CD10 and negative CD45, favoring PBL. Epstein-Barr virus-encoded RNA in situ hybridization, CD20, PAX5, Ki-67, anaplastic lymphoma kinase, human herpesvirus 8, and tissue light-chain restriction were unavailable. Bone marrow examination, serum and urine immunofixation, complete monoclonal-protein assessment, and whole-body skeletal imaging were not performed; therefore, plasmablastic myeloma could not be definitively excluded. Intensive chemotherapy was not feasible because her Eastern Cooperative Oncology Group performance status was at least 3 and she had multiorgan dysfunction, severe malnutrition, and active infections. The patient was transitioned to palliative care and subsequently died. CONCLUSIONS Discordance between apparent intestinal control and systemic deterioration should prompt urgent tissue diagnosis. The findings favor PBL within the spectrum of plasmablastic neoplasms but neither establish drug-specific causation nor definitively exclude plasmablastic myeloma.
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BibTeX
@article{znamirowski2026giant,
title = {{A Giant Intra-Abdominal Plasmablastic Neoplasm Favoring Lymphoma Mimicking an Exacerbation of Severe Fistulizing Crohn's Disease: A Case Report.}},
author = {Przemysław Znamirowski and Kaja Głowacka and Łukasz Nawacki and Marek Waluga},
journal = {The American journal of case reports},
year = {2026},
month = oct,
doi = {10.12659/ajcr.954003},
url = {https://europepmc.org/article/MED/42850874},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A Giant Intra-Abdominal Plasmablastic Neoplasm Favoring Lymphoma Mimicking an Exacerbation of Severe Fistulizing Crohn's Disease: A Case Report.
AU - Przemysław Znamirowski
AU - Kaja Głowacka
AU - Łukasz Nawacki
AU - Marek Waluga
PY - 2026
DA - 2026/10/09
JO - The American journal of case reports
DO - 10.12659/ajcr.954003
UR - https://europepmc.org/article/MED/42850874
AB - BACKGROUND Plasmablastic lymphoma (PBL) is a rare, aggressive large B-cell lymphoma associated with immunosuppression. In Crohn's disease, it can mimic disease exacerbation or infection. We describe a rapidly enlarging intra-abdominal plasmablastic neoplasm in a medically complex patient, emphasizing diagnostic vigilance without inferring a causal association with biological therapy. CASE REPORT A 44-year-old woman with severe fistulizing Crohn's disease treated sequentially with adalimumab, infliximab, and ustekinumab developed progressive systemic deterioration despite partial intestinal stabilization. Her course included portal hypertension secondary to portal vein thrombosis, refractory ascites, severe malnutrition, and recurrent systemic and multidrug-resistant infections. In September 2023 imaging showed a rapidly enlarging intra-abdominal/pelvic mass measuring more than 22 cm. Core-needle biopsy demonstrated a plasmablastic neoplasm positive for CD38, CD138, MUM1, and c-MYC, with equivocal CD10 and negative CD45, favoring PBL. Epstein-Barr virus-encoded RNA in situ hybridization, CD20, PAX5, Ki-67, anaplastic lymphoma kinase, human herpesvirus 8, and tissue light-chain restriction were unavailable. Bone marrow examination, serum and urine immunofixation, complete monoclonal-protein assessment, and whole-body skeletal imaging were not performed; therefore, plasmablastic myeloma could not be definitively excluded. Intensive chemotherapy was not feasible because her Eastern Cooperative Oncology Group performance status was at least 3 and she had multiorgan dysfunction, severe malnutrition, and active infections. The patient was transitioned to palliative care and subsequently died. CONCLUSIONS Discordance between apparent intestinal control and systemic deterioration should prompt urgent tissue diagnosis. The findings favor PBL within the spectrum of plasmablastic neoplasms but neither establish drug-specific causation nor definitively exclude plasmablastic myeloma.
SN - 1941-5923
ER -