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Diffuse large B cell lymphoma of the sigmoid colon and rectum is relatively uncommon and aggressive. Due to its nonspecific symptomatology, patients are often diagnosed late into the disease and present with life-threatening complications, such as hemorrhage, obstruction, or perforation, requiring emergent surgical intervention. Patients with colorectal lymphoma typically have inflammatory bowel disease or immunosuppression. We present a case of a 79year-old male with no known inflammatory bowel disease or immunosuppression, who had significant weight loss, diarrhea, and abdominal fullness, found by CT to have irregular wall thickening of the recto-sigmoid colon along with a colo-colonic fistula, concerning for bowel perforation. Endoscopic evaluation and biopsy confirmed the diagnosis of recto-sigmoid Diffuse large B cell lymphoma, with a PET/CT scan revealing stage IV disease. He had a partial response to six cycles of palliative reduced dose R-CHOP and is currently receiving palliative radiation to the sigmoid colon and rectum. Surgery and/or chemoradiation remain the mainstay therapy for this condition. Clinicians, however, must consider patient's functional, nutritional, and clinical status prior to choosing an optimal therapeutic regimen. This case illustrates a unique clinical presentation of this condition and the associated diagnostic and therapeutic challenges that arise in order to prevent life-threatening complications.

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INTRODUCTION: Plasmablastic lymphoma (PBL) is an exceedingly rare yet aggressive subtype of diffuse large B cell lymphoma that is most often identified in HIV-infected individuals. PBL is detected with the highest incidence in the oral cavity, with only 12% of cases being documented in the gastrointestinal tract. Even rarer are cases of PBL manifesting as intussusception, a phenomenon observed almost exclusively in children. To the author's knowledge, only two case reports of plasmablastic lymphoma presenting as intussusception (ileoileal and colonic) have been documented in the American literature since 2015. Herein the first case of PBL manifesting as ileocolonic intussusception in an immunocompromised adult is presented. CASE DESCRIPTION/METHODS: A 49-year-old man with a past medical history significant for AIDS (CD4+ 128) on intermittent HAART therapy presented with a 1-week history of sharp, bilateral lower quadrant pain and worsening abdominal distension. Admission labs revealed a mild transaminitis (AST 104 U/L, ALT 61 U/L) and lactic acidosis (2.8 mmol/L) but were otherwise unremarkable. His abdominal exam was notable for bilateral lower quadrant tenderness and marked abdominal distention. CT abdomen/pelvis with IV contrast demonstrated moderate-to-severe ascites as well as marked thickening of the terminal ileum, cecum and ascending colon with hyperemia and surrounding infiltration of fat concerning for short segment ileocolic intussusception. The patient was evaluated by general surgery and later deemed not to be a surgical candidate after several days of appearing non-obstructed. The patient subsequently underwent diagnostic and therapeutic paracentesis, with cytology consistent with plasmablastic neoplasm. Colonoscopy revealed a large, hard, partially obstructing mass in the ascending colon, with biopsy results most consistent with plasmablastic lymphoma. HHV-8 and EBV were negative on pathology. The patient was initiated on EPOCH chemotherapy by hematology/oncology and continues on therapy at the time of publication. DISCUSSION: The aforementioned case demonstrates the first known case report of PBL presenting as ileocolonic intussusception in recent review of the American literature. Taken in conjunction with other case reports documenting the association of PBL with intussusception, this case underscores that practitioners must be cognizant to include PBL in the differential diagnosis of intussusception in the immunocompromised adult so as to help expedite appropriate initiation of chemotherapy.