Diffuse large B-cell lymphoma of the rectum in a patient with Crohn's disease

Area of Science:

• Oncology
• Urology
• Gastroenterology

Background:

• A 62-year-old male with a history of Crohn's disease, subtotal colectomy, and ileostomy presented with gastrointestinal and urinary symptoms.
• The patient had previously undergone biological therapy for Crohn's disease, complicating the diagnostic and treatment pathway.

Observation:

• Initial symptoms included diarrhea and dysuria, leading to diagnoses of urinary tract infection and acute kidney injury.
• Imaging revealed a large pelvic mass compressing ureters, later identified as stage IV non-Hodgkin's diffuse large B-cell lymphoma invading the bladder.

Findings:

• The patient received chemotherapy (rituximab, cyclophosphamide, hydroxydaunomycin, oncovin, prednisolone) followed by pelvic exenteration (cystoprostatectomy, rectal stump excision, ileal conduit).
• Histology confirmed no residual malignancy post-surgery.
• One year later, the patient experienced aspiration pneumonia, urosepsis, and acute kidney injury, ultimately leading to multiorgan failure and death.

Implications:

• This case highlights the complex management of advanced pelvic malignancies in patients with pre-existing gastrointestinal conditions.
• It underscores the potential for severe complications, including sepsis and renal failure, even after successful cancer treatment and surgery.
• The case emphasizes the critical role of multidisciplinary care in managing such challenging oncological and urological emergencies.