Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 Apr 28;23(16):3003-3010.
doi: 10.3748/wjg.v23.i16.3003.

Protein-losing pseudomembranous colitis with cap polyposis-like features

Wolfgang Kreisel  1 , Guenther Ruf  1 , Richard Salm  1 , Adhara Lazaro  1 , Bertram Bengsch  1 , Anna-Maria Globig  1 , Paul Fisch  1 , Silke Lassmann  1 , Annette Schmitt-Graeff  1
Affiliations
Case Reports

Protein-losing pseudomembranous colitis with cap polyposis-like features

Wolfgang Kreisel et al. World J Gastroenterol. .

Abstract

Protein-losing enteropathy (PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.

Keywords: Cap polyposis; Goblet cells; Protein-losing enteropathy; Pseudomembranes; Ulcerative colitis.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: There was no conflict of interest.

Figures

Figure 1
Figure 1
MRI-Scan of the abdomen showing a long-segment bowel wall thickening in the distal parts of the colon.
Figure 2
Figure 2
Diffuse inflammation of the colonic mucosa spreading contiuously. The mucosa appeared to be covered by a protein-rich exudate.
Figure 3
Figure 3
Histologic appearance of the colonic mucosa. A: Erosive lesions covered by a thick pseudomembranous layer; damage of the surface epithelium and architectural disarray of the mucosa showing prominent cystic dilatation of crypts; B: Foci of mildly serrated epithelium; C, D: Abundant hyperplastic goblet cells associated with a strikingly increased accumulation of intracellular and extracellular mucus. A-C: Hematoxylin and eosin; D: Periodic acid-Schiff reaction.
Figure 4
Figure 4
Typical features of protein-losing colitis demonstrated by immunohistochemistry and special stains. A: Strong cytokeratin 20 expression (brown) by hyperplastic and attenuated (arrows) epithelial cells; B: Detection of rare CD3+ T-cells (brown, arrows) in the lamina propria and epithelium; C: Acid fuchsin orange G-stain (AFOG) stain demonstrating proteins (red) in the apical part of the denuded crypts; the granulation tissue and the pseudomembranes covering the surface, but not in the deeper parts of the mucosa; D, E: AFOG stain combined with a PAS reaction highlighting the presence of both proteins (red) and admixed mucus (pale pink, stars); E: Abundant pale pink mucus (star) but no significant proteins in the crypts lined by hyperplastic goblet cells.
Figure 5
Figure 5
Albumin (upper panel) and IgG (lower panel) levels during the course of the disease. Complete protein loss remission after surgical resection (February 6, 2014).
See this image and copyright information in PMC

References

    1. Umar SB, DiBaise JK. Protein-losing enteropathy: case illustrations and clinical review. Am J Gastroenterol. 2010;105:43–9; quiz 50. doi: 10.1038/ajg.2009.561. - DOI - PubMed
    1. Braamskamp MJ, Dolman KM, Tabbers MM. Clinical practice. Protein-losing enteropathy in children. Eur J Pediatr. 2010;169:1179–1185. doi: 10.1007/s00431-010-1235-2. - DOI - PMC - PubMed
    1. Milovic V, Grand RJ. Protein-losing gastroenteropathy - UpToDate. Available from: https://www.uptodate.com/contents/protein-losing-gastroenteropathy.
    1. Aslam N, Wright R. Protein-Losing Enteropathy: Background, Pathophysiology, Etiology. (2016) Available from: http://emedicine.medscape.com/article/182565-overview.
    1. Kovaleva V, Geissler AL, Lutz L, Fritsch R, Makowiec F, Wiesemann S, Hopt UT, Passlick B, Werner M, Lassmann S. Spatio-temporal mutation profiles of case-matched colorectal carcinomas and their metastases reveal unique de novo mutations in metachronous lung metastases by targeted next generation sequencing. Mol Cancer. 2016;15:63. doi: 10.1186/s12943-016-0549-8. - DOI - PMC - PubMed

Publication types

MeSH terms