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Weight loss in a man from West Africa
  1. Rabia Topan1,
  2. Sophie James1,
  3. Benjamin H Mullish1,
  4. Sagen Zac-Varghese2,
  5. Robert D Goldin3,
  6. Robert Thomas4,
  7. Jeremy Cox2,
  8. Jonathan M Hoare1
  1. 1Department of Gastroenterology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  3. 3Department of Histopathology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  4. 4Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Rabia Topan, Department of Gastroenterology, St Mary's Hospital, Imperial College Healthcare NHS Trust, South Wharf Road, London W2 1NY, UK; r.topan7{at}gmail.com

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Clinical presentation

A 71-year-old man was investigated for recent unintentional weight loss of approximately 15 kg (>20% total body mass) within the past 3 months. His past medical history included type 2 diabetes mellitus and hypertension, and he was an ex-smoker with a 40 pack-year history. Resident in the UK for 50 years, he was originally from Sierra Leone with no recent travel history.

Examination revealed cachexia and lymphadenopathy. Admission blood tests demonstrated a white cell count of 12.1×109/L (with eosinophil level raised at 1.0×109/L), microcytic anaemia (haemoglobin of 109 g/L with mean cell volume (MCV) of 68 fl), hypoalbuminaemia (albumin of 20 g/L) and raised inflammatory markers (C reactive protein of 62 mg/L). Tissue transglutaminase IgA levels were within normal limits, with no evidence of IgA deficiency.

An abdominal CT with contrast was …

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