# Peritoneal Lymphomatosis in a Pediatric Patient: A Peruvian Case Report

## TL;DR

A rare case of peritoneal lymphoma causing ascites in a Peruvian child is reported, highlighting the diagnostic challenges and treatment considerations.

## Contribution

This case report presents a rare pediatric presentation of DLBCL with peritoneal lymphomatosis and ascites in a Peruvian patient.

## Key findings

- DLBCL can present atypically with peritoneal symptoms and ascites in children.
- Differential diagnosis between peritoneal tuberculosis and DLBCL can be challenging due to overlapping symptoms.
- Prompt diagnosis and treatment are crucial for favorable outcomes in pediatric DLBCL cases.

## Abstract

While NHL commonly affects lymph nodes, peritoneal lymphomatosis causing ascites is rare in pediatric patients. We present a unique case of DLBC lymphoma in a Peruvian child presenting as ascites associated with peritoneal lymphomatosis. The 11-year-old boy was admitted with ascites and dyspnea. Physical examination revealed collateral circulation, abdominal distension, and diminished breath sounds. Investigations led to a suspected diagnosis of peritoneal tuberculosis; however, a laparoscopic biopsy showed granulomatous infiltration consistent with high-grade diffuse B-cell lymphoma. The peritoneal lymphomatosis causing ascites is uncommon, and its initial presentation as peritoneal symptoms is even rarer. Differential diagnosis between peritoneal tuberculosis and DLBCL involvement can be challenging due to both shared signs and symptoms. Staging systems, such as the International Pediatric NHL Staging System, aid in determining the extent of the disease. DLBCL has a good prognosis, with treatment regimens such as the LMB-89 protocol showing high overall survival rates. Awareness of DLBCL's atypical presentations is crucial for timely diagnosis and management in the pediatric population. To conclude, children with ascites represent a diagnostic challenge posed by overlapping symptoms with other conditions, such as tuberculosis, and the need for a comprehensive approach to rule out different etiologies. Additionally, it is important the prompt treatment to avoid complications.