An exotic cause of exudative enteropathy

Elena Tsourdi; Felix M Heidrich; Maria Winzer; Christoph Röllig; Christian Kirsch; Jörn Meinel; Gustavo B Baretton; Stefan R Bornstein; Lorenz C Hofbauer

doi:10.12659/AJCR.890483

An exotic cause of exudative enteropathy

Am J Case Rep. 2014 May 22:15:226-9. doi: 10.12659/AJCR.890483. eCollection 2014.

Authors

Elena Tsourdi¹, Felix M Heidrich², Maria Winzer¹, Christoph Röllig³, Christian Kirsch⁴, Jörn Meinel⁵, Gustavo B Baretton⁵, Stefan R Bornstein¹, Lorenz C Hofbauer¹

Affiliations

¹ Department of Endocrinology, Diabetes and Bone Diseases, University Clinic Dresden, Dresden, Germany.
² Department of Internal Medicine and Cardiology, Herzzentrum University Hospital, University Clinic Dresden, Dresden, Germany.
³ Department of Haematology, University Clinic Dresden, Dresden, Germany.
⁴ Department of Gastroenterology, University Clinic Dresden, Dresden, Germany.
⁵ Department of Pathology, University Clinic Dresden, Dresden, Germany.

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.