Diarrhoea, weight loss and polyposis: think Cronkhite-Canada syndrome.

A 71-year-old male presented with nausea, diarrhoea and weight loss. He had mild to moderate alopecia, paucity of eyebrow hair, erythematous non-pruritic nodular rash on the wrists, toenail onychomychosis and scalp hyperpigmentation. A colonoscopy revealed an irregular, haemorrhagic 5 cm rectosigmoid mass. Biopsies revealed mucin distended glands and focal ischemic changes. A CT scan showed numerous polypoid-like lesions in the stomach. Upper endoscopy showed mucosal erythema and nodularity with polypoid-like lesions. Biopsies showed cystic glandular dilatation, lamina propria oedema and chronic inflammation consistent with Cronkhite-Canada syndrome (CCS). The patient was started on nutrition supplementation. His skin manifestations were treated topically and with mineral supplements. He improved within 10 weeks and is currently asymptomatic. A high index of suspicion for CCS should exist in patients who present with weight loss, diarrhoea and polyposis. If diagnosed early, the disease can be treated with the goal of clinical remission.