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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 …