Bandyopadhyay Dhrubajyoti, Hajra Adrija, Ganesan Vijayan, Kar Suvrendu Sankar, Bhar Debarati, Layek Manas, Mukhopadhyay Sabyasachi, Choudhury Cankatika, Choudhary Vivek, Banerjee Prasun
Department of Accident and Emergency, Lady Hardinge Medical College, New Delhi, India.
Department of Internal Medicine, IPGMER, Kolkata, India.
Case Rep Med. 2016;2016:4210397. doi: 10.1155/2016/4210397. Epub 2016 Jan 28.
A young Indian man presented with nine-month history of chronic diarrhea, occasionally mixed with blood and intermittent colicky abdominal pain. He also complained of generalized body swelling for the last three months. On examination, he had diffuse hyperpigmentation of the skin and dystrophic nail changes. Upper and lower gastrointestinal endoscopy revealed multiple sessile polyps in the stomach, small bowel, and colon and rectum. Biopsy of polyps showed adenomatous changes with stromal edema and dilated glands. Cronkhite-Canada syndrome (CCS) was diagnosed and treated with glucocorticoids and enteral nutritional supplementation. There was an associated small intestinal bacterial overgrowth (SIBO) and stool was positive for clostridium difficile toxin. After 12 weeks of treatment, the patient achieved remission. Close correlation with clinical findings, including pertinent ectodermal abnormalities, endoscopic studies, and careful examination of biopsies will ensure a timely and correct diagnosis of CCS.
一名年轻的印度男性,有9个月的慢性腹泻病史,偶尔伴有便血及间歇性绞痛性腹痛。他还主诉在过去3个月全身肿胀。检查发现,他有皮肤弥漫性色素沉着及营养不良性指甲改变。上、下消化道内镜检查显示胃、小肠、结肠及直肠有多个无蒂息肉。息肉活检显示腺瘤样改变伴间质水肿及腺体扩张。诊断为克-卡综合征(CCS),给予糖皮质激素及肠内营养补充治疗。同时存在小肠细菌过度生长(SIBO),粪便艰难梭菌毒素检测呈阳性。治疗12周后,患者病情缓解。将临床发现,包括相关的外胚层异常、内镜检查结果以及仔细的活检检查紧密关联起来,将确保CCS得到及时、正确的诊断。