Question

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).

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 …