title: Protein-losing enteropathy caused by gastrointestinal tract-involved Langerhans cell histiocytosis.
abstract: Protein-losing enteropathy (PLE) is frequently complicated in patients with gastrointestinal tract-involved Langerhans cell histiocytosis (LCH); however, LCH per se is not generally included in the list of diseases that cause PLE. We report here a case of infantile PLE that presented with continuous diarrhea at the onset of LCH. She was initially diagnosed as having allergic gastroenteropathy and, thus, received intravenous prednisolone, which was thought to have induced immunodeficiency and consequently resulted in life-threatening cytomegalovirus-associated hemophagocytic syndrome and disseminated intravascular coagulation. Because chemotherapy for hemophagocytic syndrome was transiently effective for underlying LCH as well, the diagnosis of LCH was delayed until its recurrence. Gastrointestinal tract-involved LCH, a rare but highly fatal disease, should be considered for infants with refractory gastrointestinal symptoms, especially for those with PLE; endoscopic biopsy is strongly recommended for immediate diagnosis.
authors.affiliation: Keio University School of Medicine, Department of Pediatrics, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Haruko
authors.initials: H
authors.lastname: Shima
authors.forename: Takao
authors.initials: T
authors.lastname: Takahashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shimada
mesh_terms: D003113:Colonoscopy; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005938:Glucocorticoids / Q000009:adverse effects; D006646:Histiocytosis, Langerhans-Cell / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007223:Infant; D011239:Prednisolone / Q000009:adverse effects; D011504:Protein-Losing Enteropathies / Q000209:etiology*
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone