Gastric inflammatory myofibroblastic tumor presenting as fever of unknown origin in a 9-year-old girl Shakilu Jumanne a,b , Aika Shoo c , Livin Mumburi c , Larry Akoko b,c , Patricia Scanlan c and Michael McDermott d Background Inflammatory myofibroblastic tumor (IMT), also referred to as ‘plasma cell granuloma’, is a relatively rare mesenchymal neoplasm first described by Brunn in 1939 as a primary lung tumor [1]. Since then, several case reports of tumors with similar histological features affecting dif- ferent anatomical sites have been published [2]. IMT has a benign histological appearance composed of myofibro- blastic spindle cells mixed in an inflammatory infiltrate of lymphocytes, plasma cells, and eosinophils, but clinically it is capable of adjacent structure invasion and recurrence after resection [3,4]. The tumor is predominantly seen in children and young adults, with no sex predilection, but cases have been reported to occur in people at any age [5]. The clinical presentation of this tumor is widely variable depending on the affected site. Symptoms produced by local mass effects such as obstructive and destruction to neighboring structures are more marked in huge tumors with small lesions only characterized by nonspecific sys- temic symptoms that overlap with other common inflam- matory conditions such as infection leading to misdiagnosis and delay in appropriate intervention [6]. We hereby report a case of a 9-year-old African female child who presented with a history of fever and weight loss for 7 months, initially diagnosed as fever of unknown origin and finally found to have a gastric IMT. She underwent partial gastrectomy and splenectomy and remained asymptomatic 6 months after the procedure. Case presentation A 9-year-old female patient presented with a 7-month history of fever associated with weight loss and night sweats. She was also reported to have episodes of hema- temesis, melena, and later on hematochezia. As a result, she was admitted several times at different health facilities and received repeated courses of antibiotics and blood transfusions. These interventions brought temporary relief from fever before recurrence. She was referred to our Pediatric Oncology Unit with a suspicion of fever of unknown origin and acute leukemia due to a history of recurrent transfusion, and a complete blood count result that showed total white cell count of 47 × 10 9 /μl. On physical examination on admission to our unit, she appeared wasted, febrile with a body temperature of 39°C, pale, tachypneic, and tachycardic. On abdominal exam- ination she had a palpable left upper quadrant mass ∼ 5 × 8 cm. The rest of her physical examinations were essentially normal. Initial laboratory investigations performed included a complete blood count, which showed features of hypo- chromic microcytic anemia, hemoglobin 3.3 g/dl, mean corpuscular volume 63 fl, and mean concentration of hemoglobin of 18 g/dl. The total white cell count was 50.5 × 10 9 /μl with a differential of 82.2% neutrophils, 8.28% lymphocytes, 5.22% monocytes, and a platelet count of 703 × 10 9 /μl. A peripheral blood smear showed leukocytosis, predominantly neutrophils, with toxic gran- ules, bands, and monocytosis with high platelet count, but no blast cells were seen. Other tests performed included reticulocyte count, which was normal, Mantoux test, and sickling test; all were negative. Peripheral blood and bone marrow aspirate flow cytometry showed no hematological abnormality. Serological test conducted for Helicobacter pylori was positive, whereas HIV and hepatitis B and C were negative. Other tests included blood smear for malaria parasites, and blood, urine, and stool culture; all were negative for bacteria and parasites. Serum electro- lytes, liver function tests, and renal function tests were all within normal ranges. An esophagogastroduodenal scope was performed, which showed an ulcerated gastric mucosa in the left posterolateral aspect of the stomach with no fungating mass. A provisional diagnosis of a bleeding peptic ulcer and abdominal mass, possibly lymphoma, was made. The patient was started on intravenous antibiotics and ranitidine, and received packed RBC transfusions, but the patient was recommended for further workup to investi- gate for a palpable left upper abdominal quadrant mass. An abdominal ultrasound was performed (Fig. 1), which showed an enlarged spleen with a hypoechoic mass mea- suring 16.1 cm seemingly arising from the spleen; other organs were normal and no enlarged para-aortic lymph nodes and ascites were seen. An abdominal MRI scan (Fig. 2) was also performed and showed a huge a Department of Pediatrics and Child Health, University of Dodoma, Dodoma, b Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, c Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania and d Department of Histopathology, Our Lady’s Children’s Hospital, Dublin, Ireland Correspondence to Shakilu Jumanne, MD, Department of Pediatrics and Child Health, University of Dodoma, PO Box 395, Dodoma, Tanzania Tel/fax: + 255 26 230 009; e-mail: shakiluj@gmail.com Received 29 December 2015 Accepted 1 August 2016 European Journal of Gastroenterology & Hepatology 2017, 29:68–72 Keywords: inflammation, melena, myofibroblastic tumor, plasma cell granuloma, stomach ’ Case report 0954-691X Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MEG.0000000000000742 68 Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.