Alabama College of Osteopathic Medicine Dothan, AL, United States
Anna Crowley, BS1, Mohamad A. Eloubeidi, MD, MHS, FACG2 1Alabama College of Osteopathic Medicine, Dothan, AL; 2Anniston Digestive Health, Anniston, AL
Introduction: Pancreatic cancer typically presents with weight loss, jaundice, and a palpable gallbladder in the elderly population. It is imperative to rule out other pancreatic etiologies in a younger patient with this presentation. A young, cachectic male with abdominal pain raises suspicion of more serious etiologies, such as HIV related pathologies. This case highlights an unusual presentation of HIV associated Burkitt Lymphoma in an otherwise unsuspecting male.
Case Description/Methods: 27-year-old black male presented with right upper quadrant pain. His past medical history was unremarkable, except for a 13-pack smoking history and marijuana use. On physical examination he was jaundiced with significant epigastric tenderness. BMI was 18.9. Laboratory evaluation significant for lipase > 2250 U/L, AST 234 U/L, ALT 395 U/L, alkaline phosphatase 877 unit/L, and total bilirubin 3.7 mg/dL. Further studies revealed +HIV with viral load of 19,000, negative hepatitis panel, and positive CA-19.
Abdominal ultrasound revealed a mass in the pancreatic head with biliary and pancreatic duct dilatation and liver lesions concerning for metastases. Abdominal CT with contrast confirmed the previous and showed multiple solid hypodense lesions within the liver, measuring as large as 3.9 x 4.1 cm, adenopathy, a hypodense lesion in the tail of the pancreas, and questionable lesions in the adrenals and left lung.
EUS-guided FNA of both liver lesions and pancreatic head mass were consistent with lymphoma and suggestive of Burkitt lymphoma. Patient underwent a biliary stent placement for biliary drainage, and both oncology and infectious diseases were consulted.
Discussion: Burkitt lymphoma is the second most common neoplasm in patients with HIV, and 3% of AIDS-related illnesses are Non-Hodgkin’s lymphoma. Primary pancreatic lymphoma is a rare disease that typically manifests in the head of the pancreas. EUS-guided FNA should be considered as first line diagnostic modality in these patients.
Anna Crowley indicated no relevant financial relationships.
Mohamad Eloubeidi indicated no relevant financial relationships.
Anna Crowley, BS1, Mohamad A. Eloubeidi, MD, MHS, FACG2. P0093 - HIV-Associated Burkitt Lymphoma Mimicking Stage IV Metastatic Pancreatic Cancer, Presenting as Jaundice and Pancreatitis With EUS-Guided FNA, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.