Nikolaos Nikolaidis, Dimitrios Gkisakis, Alexander Mpoumponaris, Kaliopi Patsiaoura, Efi Zafiriadou, Nikolaos Evgenidis
Am J Case Rep 2008; 9:104-106
Background: Protein loosing enteropathy is characterized by excessive loss of proteins in the gut with subsequent clinical manifestations of hypoalbuminemia.
Case Report: We describe a case report of a patient presenting with fever, ascites, peripheral edema and hypoalbuminemia. Her liver function and urinalysis were normal and protein losing enteropathy was suspected. Upper endoscopy and duodenal biopsies revealed intestinal lymphangiectasia. Computer tomography scan showed enlarged lymph nodes in the right axilla and in the retroperitoneum. Mantoux test was positive and the histological examination of a cervical lymph node showed noncaseating granoulomatous lymphadenopathy. The patient was treated for tuberculosis with isoniazid, rifampin and pyrazinamide. She showed significant clinical improvement and twelve months later she is in good health, serum albumin and duodenal biopsies are normal and the size of lymph nodes is smaller.
Conclusions: Tuberculosis can be a rare cause of protein loosing enteropathy. We believe that this case report may contribute to the understanding of the pathogenesis of protein losing enteropathy due to granulomatous or neoplastic involvement of the Iymphatic system.
Keywords: Tuberculosis, lymphangiectasia, Ascites, hypoalbouminemia