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