Protein-losing enteropathy as a rare presentation of small bowel T-cell post-transplant lymphoproliferative disease.
Wai Au-Yang, Hei Yan Chan, Kai Shing Keith Kung et al.
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Case in brief
A kidney transplant recipient developed episodic diarrhea, with initial investigations showing no bowel pathology. She later developed fluid retention associated with hypoalbuminemia, and technetium-99m human serum albumin scintigraphy confirmed protein-losing enteropathy. Upper endoscopy, colonoscopy, and abdominal CT did not reveal significant lesions. After sudden bowel perforation, histology of the resected tissue established post-transplant monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL). She developed severe postoperative sepsis and died despite aggressive supportive treatment.
What made this case unusual
Protein-losing enteropathy was the initial manifestation of small-bowel MEITL after kidney transplantation, despite unrevealing endoscopy, colonoscopy, and CT.
Diagnostic / clinical pearl
In a transplant recipient with protein-losing enteropathy and unrevealing initial bowel investigations, small-bowel PTLD may remain undetected; tissue examination can establish the diagnosis when imaging and endoscopy are nondiagnostic.