Korean J Gastroenterol.  2012 Nov;60(5):320-324. 10.4166/kjg.2012.60.5.320.

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

• Kim SY
• Kwon JG
• Kim MH
• Oh JY
• Park JH
• Park KC
• Ryoo JI
• Ryoo HM

• KMID: 1775798
• DOI: http://doi.org/10.4166/kjg.2012.60.5.320

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 alpha1-antitrypsin clearance and bone marrow examination. After systemic chemotherapy and autologous stem cell transplantation, his clinical symptoms and abnormal laboratory findings were gradually improved.

Keyword

Protein-losing enteropathies; Precursor cell lymphoblastic leukemia-lymphoma; alpha1-antitrypsin; Drug therapy

MeSH Terms

Adult
Bone Marrow Cells/pathology
Endoscopy, Gastrointestinal
Humans
Magnetic Resonance Imaging
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*diagnosis/genetics
Protein-Losing Enteropathies/complications/*diagnosis
Thoracic Vertebrae/radiography
Tomography, X-Ray Computed
Translocation, Genetic
alpha 1-Antitrypsin/analysis
alpha 1-Antitrypsin

Figure

• 

  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).

• 

  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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