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A rare case of hypalbuminaemic oedema
  1. M Merger1,
  2. T Andus1,*,
  3. K Schlottmann1,
  4. A Timmer1,
  5. J Schölmerich1,
  6. H Messmann1,,
  7. J Marienhagen2,
  8. P Rümmle3,
  9. C Krolak4
  1. 1Department of Internal Medicine I, University of Regensburg, Germany
  2. 2Department of Nuclear Medicine, University of Regensburg, Germany
  3. 3Department of Pathology, University of Regensburg, Germany
  4. 4Department of Radiology, University of Munich, Klinikum Innenstadt, Munich, Germany
  1. Correspondence to:
    Dr M Merger
    Department of Internal Medicine, Medizinische Poliklinik, University of Würzburg, Klinikstraße 6-8, 97070 Würzburg, Germany; merger-monlinehome.de

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Clinical presentation

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 α1 antitrypsin, elastase, and fat excretion were normal. The histology of the duodenal mucosa obtained by endoscopy is shown in fig 1.

Figure 1

 Histology of the duodenal mucosa obtained by endoscopy.

Question

What is the diagnosis? How should the condition be treated?

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Footnotes

  • * Current addresses: Klinik für Allgemeine Innere Medizin, Gastroen-terologie, Hepatologie und Onkologie, Prießnitzerweg 24, 70374 Stuttgart, Germany;

  • III Medizinische Klinik, Klinikum Augsburg, 86009 Augsburg, Germany

  • Robin Spiller, Editor

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