A Rare Cause of Multisegmental Gastrointestinal Ulceration

ganomegaly or lymph nodes. Acute appendicitis was suspected on the initial ultrasound examination. She was started on antibiotic therapy with lowering of the C-reactive protein but without remission of the fever. HIV and Epstein-Barr virus serologies were negative. She was submitted to an abdominal computed tomography scan that showed a thickened gastric antrum and terminal ileum with a 3-cm pericecal abscess. An upper gastrointestinal endoscopy was then performed and showed swollen gastric mucosa and multiple ulcers scattered in the body and antrum, some of which presented with large and raised volcano-like craters (Fig. 1). An ileocolonoscopy documented multiple ulcers in all colonic segments, some of them large, confluent, and excavated, with raised borders, the largest in the cecum and splenic flexure (Fig. 2). Biopsies were taken on both of these exams, and the histopathological examination showed extensive ulceration and epithelial permeation by a diffuse lymphocytic infiltrate with smalland medium-size cells (CD56+, CD8+, CD3+, CD4+/–, CD20–, CD79a–, and PAX5–) (Fig. 3). Flow cytometry of the gastric biopsies revealed an identical monoclonal lymphocyte population. The patient had an enteropathy-associated natural killer/T-cell lymphoma (type II), an unusual presentation of this rare disease with involvement of the stomach and small and large