Case Report: A case of jejunal T-cell non-Hodgkin lymphoma with secondary bone involvement presenting as gastrointestinal perforation.

Background: Enteropathy-associated T-cell lymphoma (EATL) is a rare and highly aggressive subtype of non-Hodgkin lymphoma (NHL) that is strongly associated with celiac disease. It frequently manifests with severe complications, including intestinal obstruction or perforation, which underscores its adverse prognosis. Due to its rarity, the pathogenesis of EATL remains unclear, and standardized treatment protocols are lacking, necessitating further research to optimize management. Case report: We present the case of a 69-year-old woman whose initial manifestation was gastroduodenal perforation and acute peritonitis. Two months later, she was readmitted due to a small intestinal perforation, requiring emergency partial small-bowel resection with side-to-side jejunojejunostomy. Postoperative histopathological examination confirmed the diagnosis of EATL. Furthermore, diagnostic work-up during her hospitalization revealed secondary bone involvement, a rare finding in this disease. Conclusion: This case illustrates that EATL can manifest as life-threatening gastrointestinal perforation, which often necessitates urgent surgical intervention. It underscores the diagnostic challenge posed by this malignancy, especially when presenting atypically with rare extranodal involvement such as bone metastasis. A high index of suspicion, repeated biopsies, and early multidisciplinary collaboration are crucial for timely diagnosis and management of this aggressive lymphoma.