EDITOR'S QUIZ: GI SNAPSHOT

A rare case of hypalbuminaemic oedema

M Merger¹, T Andus^1,*, K Schlottmann¹, A Timmer¹, J Schölmerich¹, H Messmann^1,, J Marienhagen², P Rümmle³, C Krolak⁴

¹ Department of Internal Medicine I, University of Regensburg, Germany
² Department of Nuclear Medicine, University of Regensburg, Germany
³ Department of Pathology, University of Regensburg, Germany
⁴ Department of Radiology, University of Munich, Klinikum Innenstadt, Munich, Germany

Correspondence to:
Correspondence to:
Dr M Merger
Department of Internal Medicine, Medizinische Poliklinik, University of Würzburg, Klinikstraße 6-8, 97070 Würzburg, Germany; merger-m@onlinehome.de

Keywords: hypalbuminaemic oedema; budesonide; dysproteinaemia; enteropathy; lymphangiectasia; scintigraphy

The first 150 words of the full text of this article appear below.

A 35 year old male patient presented massive anasarca, eyelid oedema, and dyspnoea. He also complained of mild diarrhoea and pain in the right calf. Further examination revealed the presence of ascites, bilateral pleural, as well as pericardial effusion. Serum electrophoresis revealed severe hypo- and dysproteinaemia with dramatically reduced albumin and an increased alpha-2 peak. Tenderness of the right calf was shown to be caused by multiple arterial embolisms on angiography. Due to pronounced acceleration of the erythrocyte sedimentation rate, increased acute phase reactants fibrinogen and ferritin, normal C reactive protein, and pronounced hypercholesterolaemia (465 mg/dl), nephrotic syndrome was first suspected but was ruled out (for example, by protein excretion scintigraphy). Stool ₁ antitrypsin, elastase, and fat excretion were normal. The histology of the duodenal mucosa obtained by endoscopy is shown in fig 1.

View larger version (134K): [in this window] [in a new window]   Figure 1  Histology of the duodenal mucosa obtained by endoscopy.

 

What is the diagnosis? How should the condition . . . [Full text of this article]

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