Unusual Presentation of Paediatric Burkitt’s Lymphoma: Acute Pancreatitis and the Sequelae - A Case Report

Introduction: Non-Hodgkin Lymphoma (NHL) is the third most frequent cancer of childhood. We report an unusual presentation of Paediatric Non Hodgkin Lymphoma as acute pancreatitis and the sequelae.

Case report: An eight year old boy was referred with acute pancreatitis. He had a history of evolving multiple subcutaneous scalp nodules, fever, weight loss, abdominal pain, jaundice and renal impairment for a month. Cross sectional imaging demonstrated bilateral pleural effusions, ascites, hepatosplenomegaly, enlarged pancreas causing obstruction of the common bile duct, thickened stomach wall and enlarged kidneys.

Stomach wall and scalp nodule biopsies confirmed t(8;14) B-NHL and the disease was staged as high-risk Stage IV.

Treatment with modified chemotherapy for hepatic and renal dysfunction based on CCLG(Children’s Cancer and Leukemia Group) recommendations was commenced. Further response assessment showed necrosis in the head of the pancreas and pseudocyst formation in the tail of the pancreas. He subsequently required Insulin for endocrine pancreatic insufficiency.

He then required treatment for with invasive pulmonary aspergillosis and systemic bacterial infections which worsened the hepatic dysfunction. He developed progressive obstructive jaundice with peak bilirubin of 108umol/L after five cycles of chemotherapy. A Magnetic Resonance Cholangiopancreatogram demonstrated distal common bile duct obstruction with pancreatic necrosis and pseudocyst. He has now completed treatment and has necrotic nonfunctional chronic pancreatitis . The liver function has improved after placement of a stent in the common bile duct.

Imaging:

MRI head- scalp lesions

CT abdomen- enlarged pancreas

MRCP- pancreatic pseudocyst

MRCP- dilated CBD

Discussion: Acute pancreatitis in children is secondary to medications, trauma, anatomical abnormalities or autoimmune phenomena. Only less than 2% of Paediatric NHL patients have pancreatic involvement . Our patient represents an unusual presentation of pancreatitis and sequelae of Burkitt’s Lymphoma, the first case report in literature.

Reference:

Koca T. et al, Burkitt lymphoma with unusual presentation: Acute pancreatitis. Pediatr Int. 2015 Aug;57(4):775-7,Epub 2015 May 29.