Rituximab-Induced Colitis and Esophagitis in a Patient With Granulomatosis With Polyangiitis.

Granulomatosis with polyangiitis (GPA) is a small vessel vasculitis that affects many organ systems with varying disease severity. GPA commonly affects the sinuses and lung parenchyma. However, GPA can affect the gastrointestinal tract and may present as colitis. Immunosuppressive therapy, like rituximab (RTX), is used for the management of this disease. Rituximab is generally well-tolerated but has rare side effects that have been shown to mimic colitis in inflammatory diseases. Our case is a 44-year-old female with a history of GPA who presented with dysphagia, abdominal pain, and diarrhea. The patient received a maintenance dose of RTX six months before the presentation. The patient was seronegative for anti-neutrophilic cytoplasmic antibodies against proteinase 3 (PR3 ANCA). Infectious etiology was ruled out. Esophagogastroduodenoscopy (EGD) and colonoscopy showed esophageal bleeding ulcers and diffuse colonic inflammation, respectively. Pathology was consistent with esophagitis and colitis. Colonic mucosal biopsy failed to show evidence of vasculitis. The patient was treated with sucralfate and intravenous pantoprazole with an improvement in the symptoms. The repeat endoscopy on an outpatient basis showed the patient had full mucosal healing, including histological healing. Our patient likely had rituximab-induced colitis and esophagitis.

Gastric Glomus Tumor Presenting With Gastrointestinal Bleed and Pulmonary Embolism: A Rare Entity With Management Dilemma.

Glomus tumors are rare neoplasms originating from smooth muscle cells of the glomus body. They rarely involve the gastrointestinal tract, and when they do, they present as acute gastrointestinal bleeds with symptoms such as hematemesis or melena. We present a rare case of a gastric glomus tumor in a 50- year- old male presenting with shortness of breath and gastrointestinal bleed requiring transfusions. Coincidently, he was also found to have a pulmonary embolism that usually would require anticoagulation, which was contraindicated in an active gastrointestinal bleed. He eventually required an inferior vena cava (IVC) filter and underwent a partial gastrectomy. Due to gastric glomus tumor being a rare entity, there is a paucity of data to have a classification and grading or staging system, and tumors are usually considered benign. The exact diagnosis is dependent on histopathological findings as it can mimic a gastrointestinal stromal tumor (GIST). Pulmonary embolism, a common phenomenon, can often be seen in patients with malignancy. Our patient was diagnosed with a glomus tumor which is usually benign. As per our literature search, there are no documented cases of GGT with concomitant Pulmonary embolism diagnosis that would point to a causal association.

A Unique Case of Mantle Cell Lymphoma Masquerading as a Cecal Mass.

Mantle cell lymphoma (MCL), a type of B-cell non-Hodgkin's lymphoma, is a rare and aggressive disease with a poor prognosis due to its advanced presentation at diagnosis. It is characterized by a translocation in the Bcl-1 gene, which results in overexpression of cyclin D1. MCL is frequently seen in the form of multiple lymphomatous polyposis (MLP) in which innumerable polyps are observed in the gastrointestinal (GI) tract. In rare instances, MCL presents a single mass. The most common presentation involves male patients in their sixties, with generalized lymphadenopathy, extranodal involvement, and B symptoms (night sweats, fever, and weight loss). Endoscopic findings of MLP include cerebroid folding of the gastric mucosa and innumerable polyps extending from the duodenum to the large intestine and are reported in approximately 9% of all GI lymphomas. Less commonly, only 2-4% of GI malignancies present as a primary GI MCL as a single mass, usually in the stomach and ileocecal region in the intestine. Radiologic findings include lymphadenopathy, splenomegaly, multiple polyposis, or wall thickening with ulceration or mass formation. In most instances, advanced disease is found at diagnosis, for which 5-year survival ranges only from 26 to 46%, even when appropriate treatment is initiated. High mitotic rate, or Ki-67 index, is of prognostic value and is associated with poor prognosis. Treatment involves conventional chemo-immunotherapy consisting of R CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or RB (rituximab and bendamustine), with the latter being better tolerated and associated with longer progression-free survival. Surgical resection is usually limited to patients in which complications are seen such as bleeding, perforation, or bowel obstruction. We present a unique case of a 70-year-old male with nonbilious, nonbloody emesis, and symptomatic anemia who was found to have a cecal mass consistent with MCL.