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Kim, Kwon, Kim, Oh, Park, Park, Ryoo, and Ryoo: A Case of Acute Lymphoblastic Leukemia Presenting with Protein-Losing Enteropathy
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(5): 320-324.

Published online: 22 November 2012

DOI: https://doi.org/10.4166/kjg.2012.60.5.320

A Case of Acute Lymphoblastic Leukemia Presenting with Protein-Losing Enteropathy

Seon Young Kim, Joong Goo Kwon, Myung Hwan Kim, Jae Young Oh, Jin Hong Park, Kyung Chan Park, Jung Il Ryoo, Hun Mo Ryoo

Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

Correspondence to: Joong Goo Kwon, Department of Internal Medicine, Daegu Catholic University Hospital, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea. Tel: +82-53-650-4215, Fax: +82-53-628-4005, kwonjg@cu.ac.kr

Received 29 August 2011       Revised 18 October 2011       Accepted 18 October 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Protein-losing enteropathy (PLE) is a syndrome characterized by excessive gastrointestinal protein loss, resulting in hypoproteinemia and edema. A variety of benign and malignant conditions can be associated with PLE and acute leukemia is a very rare cause of PLE. We report a case of PLE associated with acute lymphoblastic leukemia. A 27-year-old man was admitted due to watery diarrhea, epigastric pain and bilateral leg edema. Laboratory findings showed hypoproteinemia and polycythemia. The diagnosis of PLE and acute lymphoblastic leukemia were confirmed on the measurement of fecal α1-antitrypsin clearance and bone marrow examination. After systemic chemotherapy and autologous stem cell transplantation, his clinical symptoms and abnormal laboratory findings were gradually improved.

Keywords: Protein-losing enteropathies, Precursor cell lymphoblastic leukemia-lymphoma, α1-antitrypsin, Drug therapy

Figures and Tables

Fig. 1
Abdomininal CT findings. (A) It showed diffuse edematous change of the small bowel and right-sided colon, and associated mucosal enhancement in the proximal jejunal loop (white arrow). (B) It showed multiple prominent mesenteric nodes (white arrow).
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Fig. 2
Endoscopic findings. (A) It showed multiple shallow ulcers in the duodenal second portion. (B) It showed diffuse edematous mucosa in the colon.
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Fig. 3
MRI findings of thoracolumbar spine. (A) T1 weighted image showed diffuse and patchy infiltration from T11 to S2 vertebra (white arrows). (B) T2 weighted enhanced image showed epidural and paravertebral soft tissue mass at the level of T12 and S1 (white arrows).
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Fig. 4
Bone marrow aspiration findings. (A) Lymphoblasts were irregular in size and have deeply basophilic cytoplasm containing prominent vacuoles (Wright stain, ×1,000). (B) Lymphoblasts were negative for periodic acid schiff stain (×1,000).
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Notes

Financial support: None.

Conflict of interest: None.

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