A 46-year-old male patient diagnosed with classic Hodgkin's lymphoma, mixed cellularity variety, stage IV-B with medullary, hepatic and splenic involvement, undergoing chemotherapy (scaled ECOPP).
In the chemotherapy induction phase (day 11) begins with fever, chills and melena.
Laboratory tests showed neutropenia (100 leukocytes/mm3) and platelet count.
She was admitted to the ICU due to acute respiratory failure. During admission she suffered from lower gastrointestinal bleeding with hypovolemic shock that required intubation and transfusion of blood products.
Upper endoscopy identified a large ulceration of 2-3 cm in the proximal jejunum with smooth edges and necrotic background without active bleeding.
The anatomopathological study of the biopsy taken from the edges of the ulcer showed several fragments of mucosa of the small intestine, some ulcerated, with a dense mixed inflammatory infiltrate, with numerous large cells in the foreign body, identified between
CT identified a thickening of the intestinal wall in the yey, measuring 4.5 cm in diameter and multiple lesions in both lobes of the liver and lytic involvement of the vertebral bodies at the dorsal level.
Treatment with amphotericin B was initiated, with glycemic control, and the patient underwent strenuous surgery.
The patient underwent surgery; a plastron located in and with affectation of the transverse mesocolon, with double perforation covered by the roof of the cervix.
The pathological study of the piece of resection of fibrin and ileum fat showed ulceration and intense acute and chronic inflammation with double perforation and adhesion of loops secondary to infection by Zigomycetes extensive medium-sized necrosis vessels.
The hyphae are thick, of variable diameter, branch in different angles and in the coronal sections show a clear and reinforced membrane.
These hyphae were positive with the PAS techniques and metanamine for dementia.
The patient did not experience any surgical complications.
After one year of follow-up the patient remains alive and his lymphoma is in remission.
