Clinical case

• A 33-year-old woman started with hyporexia, edema and mild abdominal pain in the last 3 months. No vomiting. No fever. No constipation, occasional diarrea.

• No previous disease. Family history: father died from lung cancer.

• Physical examination: Dehydratation. No dyspnea. Normal pulmonar and cardiac sounds. Abdomen: distension, with intestinal movements. Legs: bilateral edema; no DVT signs.

Laboratory

• Hemoglobin 6,8 g/dL.VCM 74.HCM 24.

• Normal coagulation.• Protein 3,5 g/dL. Albumina: 2 g/dL.Ig G 273 mg/dL.IgM

43 mg/dL.Ig A 74 mg/dL.Colesterol 125 mg/dL. • LDH: 602 UI/L.

• Fe: 7 mg/dL. Transferrine saturation index: 11%. Ferritine 65 ng/mL.

• Urianalysis: normal. Protein: negative.• Coombs direct: positive

Summary

• A patient without previous diasease, with a general deterioration, asthenia, weight loss in the last three months with abdominal distension, mild diarrea and edema in both legs, without proteinuria and mild diarrea.

• No fever • CONCLUSION: Cachexia/Diarrea/Small bowell

wall thick.

Gastric and small bowel wall thickening.Mesenteric adenopathy. Ascites.

SOME DAYS LATER: small bowel thickening. Pleural effusion.

Ileus. Small bowel thick and dilatated. Ascites.

Digestive functional studies

• Fecal culture: negative; no parasites.

• No steathorrea.

• D-xylosa test: normal

• Clostridium difficile toxin: negative.

• Occult fecal blood: positive.

Endoscopy studies

• Gastric biopsy: inflamatory changes, no atrophy.

• Colonoscoy: normal. No bacterias or parasites.

• Terminal ileum: normal

• Red Congo: negative