An unusual case of fever and a sigmoid mass

Abstract

A 52-year-old Afro-Caribbean female presented with a 2-week history of left iliac fossa pain and persistent fever. The working diagnosis was diverticulitis and she was treated with intravenous antibiotics. A CT scan of the abdomen showed a thickened sigmoid colon lying adjacent to the left bladder wall with infl ammatory changes present. As the patient's condition showed no improvement, an explorative laparotomy was performed, which identifi ed a mass in the sigmoid colon adherent to the bladder and left ovary. An anterior resection, partial cystectomy and a defunctioning loop-ileostomy were performed. Postoperatively, spiking fever with a high white cell count continued. No postoperative surgical complications were identifi ed despite numerous investigations. Eventually, histology of the colon revealed a null type anaplastic large cell lymphoma with a high proliferation fraction of greater than 90%. Copyright 2011 BMJ Publishing Group. All rights reserved.