LAUSR

An 83-year-old man with arterial hypertension and benign prostatic hyperplasia was referred for chronic intermittent watery diarrhea, colicky abdominal pain, asthenia, anorexia, and weight loss (15–20 kg, a 33% loss of body weight) with a year of evolution. He denied fever, skin changes, and arthralgia. The patient became dependent on others for daily routine activities. Periods of confusion and disorientation were also reported. On physical examination, evidence of severe cachexia (body mass index 15.7 kg/m2), a painless abdomen without ascites, and no palpable lymphadenopathy were observed. Upper gastrointestinal endoscopy showed duodenal diffuse whitish stippling, whose histopathological examination reported lymphangiectasias. Ileocolonoscopy with biopsies was unremarkable. Laboratory examinations revealed increased erythrocyte sedimentation rate (65 mm/h; normal: 1–20 mm/h), increased C-reactive protein (9.4 mg/dL; normal: < 0.5 mg/dL), mild lymphopenia (0.9 × 109/L; normal: 1–3 × 109/L), hypochromic microcytic anemia (hemoglobin 7.8 g/L; normal: 13–17.5 g/L, mean corpuscular volume 69.9 fL; normal: 83–101 fL), elevated prothrombin time (15.5 s; control: 11.4 s), hyponatremia (130 mmol/L; normal: 136–146 mmol/L), and hypoalbuminemia (1.9 g/dL; normal: 3.5–5.2 g/dL). Stools examination for bacteria and parasites were negative. Fecal calprotectin was superior to 6,000 mg/kg (normal: < 50 mg/kg). Interferon gamma release assay, human immunodeficiency virus, and chromogranin A were negative, and thyroid function was normal. Abdominopelvic computed tomography scan identified infracentimetric hypodense ileocolic lymph nodes. On suspicion of a protein-losing enteropathy, a Pillcam®SB3