{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T02:49:00Z","timestamp":1724381340095},"reference-count":23,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,5,4]]},"abstract":"<jats:p>Immunoproliferative small intestinal disease (IPSID) is an extra-nodal B-cell lymphoma most commonly described in the Mediterranean, Africa, and Asia. It is associated with poverty and poor sanitation, and is rarely encountered in developed countries. A 26-year-old previously healthy, Marshallese male was transferred to our facility with a 6-month history of watery diarrhea, weakness, and cachexia refractory to multiple short courses of oral antibiotics. Stool cultures grew <jats:italic>Campylobacter jejuni<\/jats:italic> and <jats:italic>Vibrio fluvialis.<\/jats:italic> Endoscopic evaluation showed histologic evidence of <jats:italic>Helicobacter pylori<\/jats:italic> gastritis and gross evidence of whipworm infection found in the colon. Mesenteric lymph node biopsy cultures grew <jats:italic>Escherichia coli.<\/jats:italic> Histopathology and immunohistochemical stains of the small intestine were consistent with IPSID. He subsequently transformed to diffuse large B-cell lymphoma (DLBCL) with tonsillar involvement despite treatment with rituximab and an extended course of antibiotics. Systemic chemotherapy with six cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone, and lenalidomide, resulted in remission of his diffuse B cell lymphoma. This case is illustrative of IPSID developing in a previously healthy individual due to overwhelming polymicrobial gastrointestinal infection by <jats:italic>C. jejuni<\/jats:italic> and other enteric pathogens with subsequent transformation to an aggressive DLBCL. IPSID should be considered in residents of developing countries presenting with refractory chronic diarrhea, weight loss, and mesenteric lymphadenopathy.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0831","type":"journal-article","created":{"date-parts":[[2016,2,23]],"date-time":"2016-02-23T03:43:42Z","timestamp":1456199022000},"page":"1177-1181","source":"Crossref","is-referenced-by-count":9,"title":["Immunoproliferative Small Intestinal Disease Associated with Overwhelming Polymicrobial Gastrointestinal Infection with Transformation to Diffuse Large B-cell Lymphoma"],"prefix":"10.4269","volume":"94","author":[{"given":"Evan C.","family":"Ewers","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L.","family":"Sheffler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viseth","family":"Ngauy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Blood","first-page":"2274","article-title":"Immunoproliferative small intestinal disease (IPSID): a model for mature B-cell neoplasms","volume":"105","author":"Al-Saleem","year":"2005"},{"key":"ref2","series-title":"N Engl J Med","first-page":"239","article-title":"Immunoproliferative small intestinal disease associated with Campylobacter jejuni","volume":"350","author":"Lecuit","year":"2004"},{"key":"ref3","series-title":"Dig Liver Dis","first-page":"799","article-title":"Immunoproliferative small intestinal disease associated with Campylobacter jejuni","volume":"44","author":"Mesnard","year":"2012"},{"year":"2014","series-title":"NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae): Non-Hodgkin's Lymphoma (Version 5.2014)","author":"National Comprehensive Cancer Network","key":"ref4"},{"key":"ref5","series-title":"Blood","first-page":"275","article-title":"Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray","volume":"103","author":"Hans","year":"2004"},{"key":"ref6","series-title":"J Clin Oncol","first-page":"251","article-title":"Lenalidomide combined with R-CHOP overcomes negative prognostic impact of non-germinal center B-cell phenotype in newly diagnosed diffuse large B-Cell lymphoma: a phase II study","volume":"33","author":"Nowakowski","year":"2015"},{"key":"ref7","series-title":"Am J Gastroenterol","first-page":"1139","article-title":"Alpha-heavy chain disease, Mediterranean lymphoma, and immunoproliferative small intestinal disease: a review of clinicopathological features, pathogenesis, and differential diagnosis","volume":"94","author":"Fine","year":"1999"},{"key":"ref8","series-title":"Clin Gastroenterol","first-page":"743","article-title":"Small intestinal lymphomas and alpha-chain disease","volume":"12","author":"Rambaud","year":"1983"},{"key":"ref9","series-title":"Gut","first-page":"311","article-title":"Changing epidemiology of IPSID in southern Iran","volume":"54","author":"Lankarani","year":"2005"},{"key":"ref10","series-title":"N Engl J Med","first-page":"1401","article-title":"Current concepts immunoproliferative small intestinal disease. 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