title: [Chronic diarrhea in a 43-year-old patient].
abstract: A 43-year old patient came to our clinic with chronic diarrhea. Determination of the faecal alpha 1-antitrypsin-clearance led to the diagnosis of exsudative enteropathy. Blood counts showed pronounced lymphocytopenia. Histopathological findings from intestinal and colorectal biopsies showed diffuse lymphangiectasis. Following exclusion of secondary types, our diagnosis was primary intestinal lymphangiectasis. Additional distinctive morphological and anamnestic features strongly suggested presence of Noonan's syndrome. Characteristic manifestations of Noonan's syndrome include changes in the lymphatic vessels in accordance with primary lymphangiectasis. Frequently, these changes are localized in the lungs. To date, only rare cases of intestinal lymphangiectasia in Noonan's syndrome have been reported. Treatment consisted of a protein-rich diet, with reduced fat content enriched by middle-chain fatty acids, as well as twice-daily injections of 200 micrograms octreotide. With this therapy, the symptoms improved.
authors.affiliation: Medizinische Klinik und Poliklinik I, Universitätsklinik Bonn. john.strehl@ukb.uni-bonn.de
authors.forename: J
authors.initials: J
authors.lastname: Strehl
authors.forename: M
authors.initials: M
authors.lastname: Schepke
authors.forename: E
authors.initials: E
authors.lastname: Wardelmann
authors.forename: W H
authors.initials: WH
authors.lastname: Caselmann
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; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008201:Lymphangiectasis, Intestinal / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D009634:Noonan Syndrome / Q000175:diagnosis* / Q000473:pathology; D011504:Protein-Losing Enteropathies / Q000175:diagnosis* / Q000473:pathology
vernacular_title: Chronische Diarrhö bei einem 43-jährigen Patienten.