Saab Omar, Algodi Marwah, Al-Obaidi Hasan, Al-Sagban Alhareth, Setrakian Sebouh, Rubio-Tapia Alberto
Hospital Medicine Department, Cleveland Clinic, Cleveland, OH.
Jersey Shore University Medical Center, Neptune, NJ.
ACG Case Rep J. 2025 Aug 4;12(8):e01800. doi: 10.14309/crj.0000000000001800. eCollection 2025 Aug.
Protein-losing enteropathy (PLE) results in the abnormal loss of proteins through the gastrointestinal tract, leading to malabsorption and hypoalbuminemia. A rare etiology of PLE is Waldenström macroglobulinemia (WM), a hematological malignancy characterized by immunoglobulin M (IgM) monoclonal gammopathy. We present a case of a 66-year-old man with a history of small bowel bacterial overgrowth and lactose intolerance, admitted for worsening gastrointestinal symptoms, including abdominal discomfort, bloating, and watery diarrhea. He had experienced significant weight loss and anasarca over 6 months. Laboratory tests indicated hypoproteinemia, hypoalbuminemia, and elevated IgM levels, accompanied by abnormal stool studies. Imaging showed no significant findings, while endoscopic evaluation revealed lymphangiectasia-like changes in the small bowel. Biopsy results demonstrated proteinaceous material in dilated villi and IgM deposition. The diagnosis of WM was confirmed by bone marrow biopsy. Thus, WM should be considered when evaluating unexplained PLE, particularly with associated gastrointestinal symptoms and elevated IgM levels.
蛋白丢失性肠病（PLE）导致蛋白质通过胃肠道异常丢失，进而引起吸收不良和低蛋白血症。PLE的一种罕见病因是华氏巨球蛋白血症（WM），这是一种以免疫球蛋白M（IgM）单克隆丙种球蛋白病为特征的血液系统恶性肿瘤。我们报告一例66岁男性病例，该患者有小肠细菌过度生长和乳糖不耐受病史，因胃肠道症状恶化入院，包括腹部不适、腹胀和水样腹泻。他在6个月内体重显著减轻并出现全身水肿。实验室检查显示低蛋白血症、低白蛋白血症和IgM水平升高，同时粪便检查异常。影像学检查未发现明显异常，而内镜评估显示小肠有类似淋巴管扩张的改变。活检结果显示扩张绒毛中有蛋白质样物质和IgM沉积。骨髓活检确诊为WM。因此，在评估不明原因的PLE时，尤其是伴有胃肠道症状和IgM水平升高时，应考虑WM。
