Diagnostic Difficulties in Adolescents Presenting with Polyserositis

Background: Polyserositis is defined as the inflammation of serous membranes associated with serous effusion. Differential diagnosis is often difficult because polyserositis occurs in various conditions. It is frequently associated with tuberculosis (TB), autoimmune diseases, tumors, rarely with sepsis or other infections.

Objective: The aim of this paper is to highlight the necessity of a diagnostic protocol for children presenting with polyserositis.

Methods: We present the cases of two patients admitted to our hospital with pleural and peritoneal effusion who were diagnosed with Non-Hodgkin intestinal lymphoma.

Results: A 12 year-old girl was admitted to our department after 5 days history of fever, cough, chest pain, abdominal pain and weight loss. Laboratory tests showed high inflammatory markers and the chest X-ray was suggestive for bilateral pleural effusion. TB was considered for the differential diagnosis, but in was excluded. CT scan showed massive pleural and peritoneal effusion with gastric distention. Exploratory laparoscopy revealed a compressive mass in the duodeno-jejunal angle with abnormal aspect of the intestinal loops, fibrin deposits and multiple adherences. Excisional biopsy was performed and the diagnosis of anaplastic lymphoma was established (histology and immunohistochemistry).
A 15 year-old boy was transferred to our hospital with the suspicion of liver disease. The patient had a history of abdominal pain, vomiting and abdominal distension with onset of 4 days. Abdominal ultrasound identified peritoneal and pleural effusion and an abdominal mass. Laparotomy showed peritoneal carcinomatosis, large intestinal tumor 30 cm before the ileo-cecal valve. After assessment of biopsies, Burkitt Lymphoma was diagnosed.
Both patients were started on specific treatment, but the second patient had a fulminant evolution and died in the 18^th day of admission.

Conclusion: Polyserosistis can present as a complication of lymphomas. The diagnosis should be considered even in case of sudden onset. A suitable assessment should be made to establish the accurate diagnosis.