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Small bowel biopsies revealed diffuse nodular lymphoid hyperplasia (NLH), a rare lymphoproliferative condition characterised by numerous hyperplastic lymphoid nodules, 3–6 mm in diameter. The nodules are indistinguishable from those that normally occur in the gastrointestinal tract. NLH is most commonly seen in the small bowel. The exact aetiology of the condition is unknown but there is an association with immunodeficiency. Measurement of her serum immunoglobulins levels revealed hypogammaglobulinaemia consistent with common variable immunodeficiency. This is associated with recurrent sinopulmonary bacterial infections and gastrointestinal disorders, most commonly chronic diarrhoea. Her anaemia improved with oral iron supplementation and she was commenced on intravenous immunoglobulin therapy.

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