Appendicular Peritonitis Related to Burkitt Lymphoma: Case Report

Case Report

Austin Crit Care Case Rep. 2024; 8(1): 1047.

Appendicular Peritonitis Related to Burkitt Lymphoma: Case Report

Zarate Alejandro J1,2*; Mena Pezo Valentina A1

1Department of Surgery, Universidad Finis Terrae, Santiago, Chile

2Colorectal Unit, Clínica las Condes, Chile

*Corresponding author: Zarate Alejandro J, MD Department of Surgery, Universidad Finis Terrae. Pedro de Valdivia avenue 1509, Santiago Chile. Tel: 56224207100 Email: azarate@uft.cl

Received: January 17, 2024 Accepted: February 21, 2024 Published: February 28, 2024

Abstract

Burkitt lymphoma is an aggressive type of non Hodgkin lymphoma, it is infrequent the presentation as appendicitis and is even more infrequent like appendicular peritonitis in adults. Clinic case: We reported a case of a 36-year-old man, who consulted with acute abdominal pain and fever. The physical examination showed abdominal resistance. An abdominal and pelvic computed tomography showed an increased in size appendix, perforated and a suspected tumoral mass. Surgery was performed, it was identified a tumoral mass dependent on the appendix, with compromise of cecum, subsequently a right hemicolectomy with primary anastomosis was performed. The histopathology showed Burkitt lymphoma. This article reports on a rare case of appendicular peritonitis in adults caused by Burkitt lymphoma and a review of the current evidence.

Keywords: Appendicular peritonitis; Burkitt lymphoma; Non Hodgkin lymphoma; Abdominal pain

Introduction

Non Hodgkin Lymphoma; (NL); is a heterogeneous group of pathologies of the immune system, with major prevalence in B cells [1]. The prevalence in E.E.U.U. is 19/100.000 persons [2]. Clinical manifestations include painless adenopathies, fever, weight loss, fatigue and itching [3].

Burkitt Lymphoma (BL); is a B cell lymphoma with high proliferation rate [4], is more common in kids and teenegers with a prevalence rate of 3-6 cases/100.000 persons [3-5]. Risk factors more relevant are immunosuppression, autoimmune disease, bacterial and viral infections [1].

Exist three types of BL:

- Endemic.

- Associated with immunodeficiency.

- Sporadic.

Endemic BL originates to areas where malaria is holoendemic [6] and is associated with infection with Epstein Barr virus [7]. Patients often present with an tumoral mass in jaw, orbit and abdomen [8]. Associated with immunodeficiency BL is associated with HIV infection, and affects marrow bone and gastrointestinal tract [9].

Sporadic BL typically occurs in children [10]. It affects more men than women. This type of BL usually occurs in the abdomen with compromise of ileocecal region, mimicking an acute appendix or an intestinal obstruction [3].

BL is diagnosed with clinical findings, CT and PET CT, biopsy, immunophenotype and molecular study [11].

Since BL is a rare medical condition in adults, we consulted the terms appendicular peritonitis and BL in PUBMED, SciELO, LILACS and Web of Knowledge in order to be able to write a case report and a review of the current evidence

Clinical Case

A 36-year-old male with a clinical history of dyslipidemia, operated testicular cancer. Non-smoker. Consulted in the emergency room with a three-day episode of abdominal pain, focused on right lower abdominal quadrant and fever.

During the physical examination; in the emergency department, vital signs showed: axillary temperature of 38°C, tachycardic, distended abdomen, tympanic, soft, depressible, pain in right lower abdominal quadrant and peri umbilical zone, and signs of peritoneal irritation.

Laboratory examinations showed elevation of C reactive protein and white blood cell count. Abdomen and pelvic CT scan with contrast reported (Figure 1): appendix with signs of increase of diameter, perforated, with free liquid in the pelvis, associated a mass in appendix zone, suspicious of malignant mass.