Yousuf Mohamed Yousha, Imran Faraz, Davis Andrew
North Devon Hospital, MAU, Flat 2, Kipling House, NDDH, Barnstaple EX31 4HX, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0551. Epub 2009 Feb 27.
This patient, known to have ectodermal dysplasia, was referred to the hospital to investigate the cause for his significant pedal oedema and hypoproteinaemia. Investigations ruled out protein loss from the kidney and there was no evidence of chronic liver disease. Protein-losing enteropathy became a diagnosis of exclusion. To investigate it further, he underwent an oral gastroduodenoscopy and a computed tomography scan of the abdomen, which showed an abnormal duodenal mucosa and extensive retroperitoneal lymphadenopathy. Biopsies confirmed this to be grade II follicular non-Hodgkin lymphoma. The lymphadenopathy was causing obstructive hydronephrosis, which required a nephrostomy. He received a course of steroids and chemotherapy. His condition, however, deteriorated and he died.
该患者已知患有外胚层发育不良,因严重足部水肿和低蛋白血症被转诊至我院进行病因调查。检查排除了肾脏蛋白丢失,且无慢性肝病证据。蛋白丢失性肠病成为排除性诊断。为进一步检查,他接受了口服胃十二指肠镜检查和腹部计算机断层扫描,结果显示十二指肠黏膜异常和广泛的腹膜后淋巴结病。活检证实为II级滤泡性非霍奇金淋巴瘤。淋巴结病导致梗阻性肾积水,需要进行肾造瘘术。他接受了一个疗程的类固醇和化疗。然而,他的病情恶化,最终死亡。