A Giant Intra-Abdominal Plasmablastic Neoplasm Favoring Lymphoma Mimicking an Exacerbation of Severe Fistulizing Crohn's Disease: A Case Report.
Przemysław Znamirowski, Kaja Głowacka, Łukasz Nawacki et al.
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Case in brief
A 44-year-old woman with severe fistulizing Crohn’s disease developed progressive systemic deterioration despite partial intestinal stabilization. She also had portal hypertension from portal vein thrombosis, refractory ascites, severe malnutrition, and recurrent infections. Imaging revealed a rapidly enlarging intra-abdominal/pelvic mass exceeding 22 cm. Biopsy showed a plasmablastic neoplasm with an immunophenotype favoring plasmablastic lymphoma (PBL), although key studies were unavailable and plasmablastic myeloma could not be definitively excluded. Multiorgan dysfunction, poor performance status, malnutrition, and active infections precluded intensive chemotherapy. She transitioned to palliative care and died.
What made this case unusual
The giant, rapidly enlarging mass presented amid severe fistulizing Crohn’s disease and could be mistaken for an exacerbation or infection, despite partial intestinal stabilization. The available workup favored PBL but did not definitively exclude plasmablastic myeloma.
Diagnostic / clinical pearl
When systemic deterioration diverges from apparent intestinal control in Crohn’s disease, pursue urgent tissue diagnosis rather than assuming an inflammatory flare or infection.
Why it matters
The biopsy supported PBL but the incomplete diagnostic workup left plasmablastic myeloma unresolved; the report also does not establish a causal link to biologic therapy.