ACG Case Reports Journal · 6 authors, 2 centres
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A case report describes a 61-year-old woman with marginal cell lymphoma who developed severe, relapsing chronic diarrhea and persistent apoptotic enteropathy despite hematological remission and discontinuation of chemotherapy for 1 year. The authors propose that secondary hypogammaglobulinemia induced by her chemotherapy likely contributed to the apoptotic enteropathy.
This is a case report of a 61-year-old woman with marginal cell lymphoma (MCL) who presented with a 5-week history of severe diarrhea (>2 L/d). Workup revealed apoptotic enteropathy on colon and duodenal biopsies. Extensive evaluations for infections, autoimmune causes, and medication side effects were negative. Her diarrhea persisted despite treatment with various antidiarrheal agents, with only a transient response to a steroid taper. Three months later, she required intensive care for complications of her diarrhea, and repeat biopsies still showed crypt apoptosis. She was found to have hypogammaglobulinemia. The authors propose that this secondary hypogammaglobulinemia, likely induced by her MCL chemotherapy (rituximab, obinutuzumab, bendamustine), contributed to the apoptotic enteropathy, though the mechanistic connection is unknown.
