title: Protein-losing enteropathy in Crohn's disease.
abstract: Protein-losing enteropathy (PLE) is a rare but severe complication of Crohn's disease (CD) and hypoalbuminemia can be one of the presenting symptoms of this illness. The diagnosis of PLE can only be made after exclusion of malnutrition and liver or kidney failure. Significant intestinal leakage can be caused by mucosal injury, increased lymphatic pressure or dilated lymphatics and has been reported in a large number of diseases. The protein-losing can be diagnosed by assessing the excretion of different radiolabeled macromolecules in the faeces or by the clearance of alpha-1-antitrypsine in stools. The primary approach should be the optimization of the nutritional status. Medical treatment of the underlying disease is primordial. In other cases surgical resection of the most affected areas is inevitable. We report a case of a 21-year-old male with a 4 year history of CD, who developed significant hypoproteinemia with pitting oedema, initially in the absence of any other sign of severe disease activity. A "Cr-chloride albumin excretion confirmed our hypothesis of protein-losing enteropathy. Because of sub-obstruction signs some months later, a laparotomy was performed which revealed a severely affected loop with dilatation of the proximal jejunum. Interestingly, multiple large lymph nodes and dilated lymphatics were seen. A partial jejunal resection was performed for stricturing Crohn's disease. Histology showed severe mesenteric granulomatosis, dilated lymph vessels and granulomatous vasculitis. After the resection our patient improved without further albumin infusions and the oedema resolved.
authors.affiliation: Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
authors.forename: Freddy
authors.initials: F
authors.lastname: Penninckx
authors.forename: Gert
authors.initials: G
authors.lastname: De Hertogh
authors.forename: Karel
authors.initials: K
authors.lastname: Geboes
authors.forename: Andre
authors.initials: A
authors.lastname: D'Hoore
authors.forename: Maja
authors.initials: M
authors.lastname: Noman
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D011504:Protein-Losing Enteropathies / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome