An exotic cause of exudative enteropathy

Abstract

Patient: Male, 50 FINAL DIAGNOSIS: Exudative enteropathy Symptoms: Abdominal pain • diarrhea • fever • hyponatremia • lymphadenopathy • weight loss

Medication: - Clinical Procedure: - Specialty: -

Objective: Unusual clinical course.

Background: Protein-losing enteropathy is a rare cause of hypoproteinemia. Erosive and non-erosive gastrointestinal diseases as well as vascular disorders that result in increased central venous pressure or mesenteric lymphatic obstruction may result in protein loss via the gastrointestinal tract.

Case report: We present the case of a 50-year-old man with protein-losing enteropathy, who had profuse diarrhea, abdominal pain, lymphadenopathy, fever, and a weight loss of 10 kg in the preceding 2 months. Extensive work-up revealed infection with Giardia lamblia. We review clinical signs and symptoms, laboratory findings, and imaging studies, and discuss potential pitfalls in establishing the diagnosis.

Conclusions: To the best of our knowledge, this represents one of the few published cases of intestinal giardiasis as a cause of protein-losing enteropathy in an immunocompetent adult. The diagnosis of lambliasis should be based on a combination of stool cultures and serum serology, and in cases of high clinical suspicion, an endoscopy and biopsy of the upper GI tract is recommended.

Keywords: Giardia Lamblia – pathogenicity; Protein-Losing Enteropathies – diagnosis; Protein-Losing Enteropathies – etiology; Protein-Losing Enteropathies – parasitology; Protein-Losing Enteropathies – therapy.

Figure 1

(A) Duodenal mucosa (H&E, 10×) with focally complete villous atrophy and moderate lymphoplasmocytic and granulocytic infiltration of the L. propria, cryptitis, and focal crypt abscesses (arrow). (B) Multiple Giardia lamblia trophozoites (arrow) adjacent to the apical duodenal epithelium (H&E, 40×).