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Seventy-five-year-old man with unexplained weight loss and alopecia
  1. Elmer Hoekstra1,2,
  2. Jaap van der Laan2,
  3. Michael van der Voorn2
  1. 1 Department of Gastroenterology and Hepatology, Leids Universitair Medisch Centrum, LUMC, Leiden, Zuid-Holland, The Netherlands
  2. 2 Department of Gastroenterology and Hepatology, HagaZiekenhuis Locatie Leyweg, Den Haag, Zuid-Holland, The Netherlands
  1. Correspondence to Dr Elmer Hoekstra, Gastroenterology and Hepatology, LUMC, Leiden 2300 RC, The Netherlands; e.hoekstra{at}

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A 75-year-old white carpenter presented with unexplained weight loss of 25 kg in the last 6 months. He lost his appetite, but denied any other gastrointestinal complaints and his stools were normal. Strikingly, he had lost his fingernails, had complaints of hair loss and had purple discolouration of his hand palms and soles of his feet. On physical examination, we saw a cachectic patient who had lost his fingernails (figure 1).

Figure 1

Loss of fingernails.

Laboratory findings were unremarkable, with normal serum albumin and electrolytes, no anaemia and no vitamin deficiencies. Imaging using chest X-ray and abdominal ultrasound were normal. Oesophago-gastro-duodenoscopy showed hypertrophic (strawberry-like) pangastritis and enteritis (figure 2), while colonoscopy showed a highly …

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  • Contributors EH: acquisition of data and drafting of the manuscript. JvdL: drafting of the manuscript. MvdV: drafting of the manuscript and supervision of study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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