Plasmablastic lymphoma in an HIV-positive patient operated on for suspected stump appendicitis: a case report

Abstract

Background: Stump appendicitis is a rare delayed complication after appendectomy. Neoplastic processes mimicking this entity are exceptional. In HIV-positive patients, gastrointestinal lymphoproliferative disorders must be considered in the differential diagnosis. Objective: To describe the clinical presentation, surgical management, and pathological findings of an HIV-positive patient operated on for suspected stump appendicitis. Case presentation: A descriptive case report from Hospital General de Luque. Clinical assessment, laboratory and ultrasound findings, laparoscopic findings, histopathological and immunohistochemical examination, and in-hospital outcomes are presented. A 32-year-old HIV-positive male with a history of appendectomy 10 years prior presented with 30 hours of epigastric pain radiating to the right iliac fossa. He had localized tenderness with guarding, without signs of generalized peritoneal irritation. Clinical scores were Alvarado 4, AIR 3, and RIPASA 8. Laboratory findings: leukopenia (3,780/mm³) and CRP 5.1 mg/L. Ultrasound showed a non-compressible 9-mm tubular structure arising from the cecum with surrounding inflammatory changes and free fluid. Diagnostic laparoscopy revealed an inflamed tubular structure consistent with an appendiceal stump, and a laparoscopic stump resection was performed. The pathological examination confirmed plasmablastic lymphoma. Discussion: Right iliac fossa pain after appendectomy is not always due to stump appendicitis. In immunocompromised patients, lymphoproliferative disorders should be considered. Routine histopathological evaluation remains essential for accurate diagnosis.