S3445 Microscopic Enteritis: A Rare Manifestation of T-cell Promyelocytic Leukemia

• DOI: 10.14309/01.ajg.0000870420.49063.9f
• Publication Date: 2023-01-14T00:34:53Z
• Authors: Hiral Patel; Robert D. Dorrell
• Keywords: Intraepithelial lymphocyte; Leukocytosis; Elevated alkaline phosphatase

Introduction: An abnormal infiltration of intraepithelial lymphocytes in the intestinal mucosa is described as microscopic enteritis (ME). ME a heterogeneous condition that can be found in, but not limited to, celiac disease, autoimmune disorders, food protein intolerance, parasitic infections, and NSAID use. Thus, an obvious cause difficult to elucidate requires thorough work up. We report case patient who was have thought secondary infiltrative T-cell promyelocytic leukemia (T-PLL). Case Description/Methods: A 68-year-old male with history type II diabetes hyperlipidemia presented intermittent fever, abdominal pain, nausea, emesis. He small bowel obstruction severe 3/4 (distal jejunum ileocecal valve). had resection pathology revealing necrotizing lymphocytic enteritis. Bidirectional endoscopy revealed mild colonic, ileal duodenal edema biopsies increased lymphocytes. empirically treated intravenous methylprednisolone resolution fevers. discharged home follow up gastroenterology for hematology persistent leukocytosis. continued recurrent fevers leukocytosis (14,200 WBC/microliter). Infectious (acid fast bacteria, fungi, cytomegalovirus, adenovirus, syphilis) rheumatologic diagnostics were unrevealing. underwent bone marrow biopsy peripheral blood examination immunostains, flow cytometry, cytogenetic studies clonal receptor gamma gene rearrangement concerning T-PLL. alemtuzumab; however developed worsening disease disseminating opportunistic infections (cytomegalovirus aspergillosis). passed away shortly after his diagnosis. Discussion: challenging diagnosis its etiology elucidate. Prompt, timely evaluation should prioritized improve outcomes. T-PLL rare due growth T-lymphocytes typically presents leukocytosis, weight loss, infection; however, gastrointestinal symptoms may presenting symptom.