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A 68-year-old man was admitted to our clinic because of vomiting. He had no notable past history. He was a social drinker, and developed abdominal distension for a few weeks before admission. Ileus was found in the small intestine on computed tomography (CT) of the abdomen. An intestinal tube was inserted, but his symptom remained. Further examination revealed that the cause of ileus was a tumor mass in the small intestine. Laparoscopic-assisted partial excision of small intestine was performed. The pathological diagnosis of the small intestinal mass was diffuse large B-cell lymphoma (DLBCL), germinal center B-cell-like. He was referred to the hematological division for additional chemotherapy. FDG-positron emission tomography (PET) was performed and uptake in the gastric lesion was observed. Upper endoscopy revealed concomitant MALT lymphoma. Amoxicillin, clarithromycin and omeprazole were prescribed for the treatment of Helicobacter pylori. Rituximabcombined CHOP (R-CHOP) therapy was started to treat stage I DLBCL. Trimethoprim-sulfamethoxazole, an H2 blocker, was administered to prevent Pneumocystis carinii pneumonia and gastric ulcer. No hepatotoxicity was observed during the first cycle of R-CHOP therapy. After 2 cycles, slight increases in liver enzymes were noted on laboratory testing; aspartate aminotransferase (AST) 80 IU/L (reference range: 5-40), alanine aminotransferase (ALT) 123 IU/ L (reference range: 5-35) and γ-glutamyl transpeptidase (GGT) 22 IU/L (reference range: 8-64) (Fig. 1). As the patient exhibited no symptoms, R-CHOP therapy was continued with caution. After 3 cycles, AST, ALT and GGT levels increased to 195, 243 and 257 IU/L, respect ively. Ultrasonography and CT of the abdomen demonstrated no DLBCL developed into fatal liver failure during rituximabcontaining chemotherapy

DLBCL developed into fatal liver failure during rituximab-containing chemotherapy