Terminal Ileitis: An Unexpected Presentation of Diffuse Large B-Cell Lymphoma in Well-Controlled HIV

Presented in 15th World Gastroenterology, IBD & Hepatology Conference from December 17-19, 2025, in Dubai, UAE & Online. 

Speaker Name: Dr. Susan Kais
Location: US
Category: (Speaker )

Global Journal of Gastroenterology & Hepatology Research [GJGHR]
Visit Speaker page: https://gastroenterology.utilitarianconferences.com/speaker/dr-susan-kais

Introduction

Non-Hodgkin lymphomas (NHL) involving the gastrointestinal (GI) tract can have a nonspecific and variable clinical presentation. This case describes a patient with well-controlled human immunodeficiency virus (HIV) diagnosed with diffuse large B-cell lymphoma (DLBCL), highlighting the importance of including lymphomas in the differential diagnosis in patients with HIV, regardless of CD4 count or antiretroviral therapy (ART) adherence.

Case Description

A 58-year-old male with well-controlled HIV on ART, obesity, and recent aphthous ulcers presented with acute abdominal pain and non-bloody diarrhea. His pain started periumbilically but migrated to his right lower quadrant, accompanied by fever and chills. CT revealed distal ileal thickening. Colonoscopy six years prior was unremarkable. Recent lab work showed a CD4 count of 877 cells/uL and a low viral load. Differentials for his ileitis were broad and included inflammatory bowel disease (given recent aphthous ulcers), small bowel malignancy (given HIV, obesity, tobacco use), opportunistic infections, and ART related.

The patient underwent bidirectional endoscopy; EGD was unremarkable, but colonoscopy showed ulcerated mucosa in the distal ileum. Biopsy demonstrated cytomegalovirus inclusions, and atypical immunostains were consistent with activated B-cell DLBCL, an aggressive DLBCL subtype. Positron emission tomography scan showed disease limited to the distal ileum. The patient was referred to oncology and started chemotherapy.

Discussion

Gastrointestinal lymphomas account for 10-15% of all NHLs and 1-4% of all GI malignancies. Often the result of extranodal involvement of NHL, primary GI NHLs are rare, and less than 10% present in the small bowel. DLBCL is the most common subtype of NHL, with an annual incidence of 7.2 cases per 100,000 people in the U.S. The incidence of DLBCL in patients with well-treated HIV is higher than in immunocompetent individuals, and more than one-third of patients with HIV and DLBCL have CD4 counts >200 cells/uL when diagnosed.

Multi-agent chemotherapy is the mainstay of treatment. The overall prognosis of patients with HIV-associated DLBCL on ART is comparable to that of HIV-negative patients, with two-year overall survival rates of approximately 75%.

Our case of a patient with an atypical location of an aggressive subtype of DLBCL, diagnosed at an early stage, highlights the importance of considering lymphoma in HIV-positive patients presenting with GI symptoms, regardless of CD4 count or ART adherence.

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Crohn’s and Colitis Journals | Gastroenterology & Hepatology Journals | Gastroenterology Journals | Research Gastroenterology and Hepatology Journals | Clinical and Experimental Gastroenterology Journals | Gastrointestinal Endoscopy Journals | Therapeutic Advances in Gastroenterology Journals | Colorectal Disease: clinical and molecular gastroenterology and surgery Journals | Inflammatory Bowel Diseases Journals | Expert Review of Gastroenterology & Hepatology Journals | Clinical Colorectal Journals | Cancer Gut Journals | Endoscopy Journals | Hepatitis B Annual Journals | Hepato-biliary-Pancreatic Sciences Journals | Medical Bulletin Journals 

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