title: [Libyan patient with chronic diarrhea].
abstract: A 22-year-old Libyan patient suffering from chronic diarrhea presented with an alpha-heavy chain paraprotein and a lympho-plasmacellular lymphoma infiltration of the duodenal mucosa. These findings supported the diagnosis of "immunoproliferative small intestinal disease" (IPSID). In this disease, that occurs almost solely in countries with low socioeconomic status, a diffuse infiltration of small intestinal mucosa by neoplastic lymphoid cells causes chronic malabsorption. About 65% of patients exhibit a paraprotein in serum, urine or jejunal juice that consists of the heavy chain of immunoglobulin A (alpha-heavy chain). In advanced stages, IPSID resembles histologically and clinically high grade lymphoma: some patients develop masses in the gut wall, an abdominal lymphadenopathy and involvement of other organs including bone marrow. The disease is believed to be triggered by a chronic infectious antigenic stimulus. Thus, in early stages in some patients cure may be achieved by antibiotic therapy alone. In advanced disease, chemotherapy including anthracyclins is necessary.
authors.affiliation: Medizinische Klinik und Poliklinik-Allgemeine Innere Medizin und Pathologisches Institut, Universität Bonn sowie Innere Medizin-Rheumatologie, Brüderkrankenhaus St. Petrus, Bonn.
authors.forename: J
authors.initials: J
authors.lastname: Mezger
authors.forename: P
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: A
authors.initials: A
authors.lastname: Glasmacher
authors.forename: T H
authors.initials: TH
authors.lastname: Breuer
authors.forename: H P
authors.initials: HP
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Meybehm
authors.forename: H J
authors.initials: HJ
authors.lastname: Kipnowski
authors.forename: T
authors.initials: T
authors.lastname: Sauerbruch
mesh_terms: D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology* / Q000473:pathology; D004384:Duodenoscopy; D004386:Duodenum / Q000473:pathology; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D007124:Immunoenzyme Techniques; D007070:Immunoglobulin A / Q000378:metabolism; D007143:Immunoglobulin Heavy Chains / Q000378:metabolism; D007161:Immunoproliferative Small Intestinal Disease / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D008099:Liver / Q000473:pathology; D008297:Male; D010950:Plasma Cells / Q000473:pathology
chemical_list: D007070:Immunoglobulin A; D007143:Immunoglobulin Heavy Chains