# Recurrent Acute Upper Gastrointestinal Bleed Due to Diffuse B-cell Lymphoma of the Duodenum in a Renal Transplant Patient: A Case Report and Literature Review

## TL;DR

A kidney transplant patient developed a rare type of lymphoma in the duodenum, leading to severe and recurring gastrointestinal bleeding.

## Contribution

This case report highlights the rare occurrence of post-transplant lymphoproliferative disorder presenting as a duodenal diffuse B-cell lymphoma with severe bleeding.

## Key findings

- A renal transplant patient presented with an upper GI bleed due to diffuse large B-cell lymphoma in the duodenum.
- The patient experienced hemorrhagic shock after one cycle of R-CHOP chemotherapy.
- Post-transplant lymphoproliferative disorders can present up to 10 years post-transplant and are at high risk for bleeding.

## Abstract

A patient status post (s/p) renal transplantation in 2014 presented with an upper gastrointestinal bleed (UGIB). The source of the bleed was found to be a large mass in the duodenum with histopathology from biopsies obtained during esophagogastroduodenoscopy revealing diffuse large B-cell lymphoma (DLBCL) of the duodenum. His mycophenolate was stopped, and the tacrolimus dose was reduced due to active malignancy. He was discharged and completed one cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) before presenting back to ED with hemorrhagic shock from a large upper GI bleed requiring admission to the medical intensive care unit. Post-transplant lymphoproliferative disorders such as DBLCL can present 10 years from the transplant date. These malignancies are at high risk for bleed, especially after treatment with chemotherapy is initiated.