Hardikkumar Bhanderi, MD, Anosh Khan, MD, Farhan Khalid, MD, Doantrang Du, MD Monmouth Medical Center, Long Branch, NJ
Introduction: Protein losing enteropathy(PLE) have many etiologies including genetic as well as secondary to other pathological conditions, some of them are rare and some of them are quite common. Lymphoma leading to protein losing enteropathy is one of those rare cause. We present a case of 76 year old male with PLE caused by Mantle Cell lymphoma.
Case Description/Methods: 76-year-old male with past medical history of Mantle Cell Lymphoma, diagnosed in October, 2022, was in remission after 4 cycle of Rituximab and Bendamustine; 6th cycle 6 weeks ago, mesenteric panniculitis in 2018, Hypertension, Hyperlipidemia came to the emergency department(ED) with chief complaint of severe right lower quadrant abdominal pain of several month duration, 10/10 in severity, non-radiating, dull in nature along with frequent loose bowel movement, 50 lb weight loss over the past several months. He was admitted with similar complaints around a month ago. His initial vitals were BP 118/80 mmHg, HR 102/min, RR 20/min and he was afebrile. Physical examination was significant only for right lower quadrant tenderness without rebound tenderness, rigidity or guarding. Initial blood work up significant for platelet count of 95 K/CMM, AST of 43 Unit/L, ALT of 57 Unit/L, Total protein of 5.3 g/dL with Albumin of 3.6 g/dL. CT scan of abdomen and pelvis with contrast showed 12 mm mesenteric lymph node. Stool culture was negative for any infection. He underwent diagnostic laparoscopy, which showed small bowel lymphatic congestion. He continued to have diarrhea for at least 3-4 days, lead to protein level of 4.6 g/dL with albumin of 3 g/dL. Frequency of bowel movements eventually decreased, but stool consistency continued to be loose and he was discharged. He is on maintenance Rituxan therapy right now.
Discussion: PLE caused by erosive disease, non-erosive disease and lymphatic disorders. Its presenting symptoms often overlap with presentation and course of malignancy, making it a diagnostic challenge. The unique part of our case is the development of PLE in the remission phase of mantle cell lymphoma and absence of significant lymphadenopathy on imaging and laparoscopy. Moreover, chemotherapy leads to improvement in PLE which stands in contrast in our case. The presence of small bowel lymphatic congestion in our patient most likely due to microscopic or subclinical peritoneal lymphadenopathy is the most plausible explanation. Nutritional support and continuation of chemotherapy leads to resolution of lymphadenopathy, abating PLE overtime.
Hardikkumar Bhanderi indicated no relevant financial relationships.
Anosh Khan indicated no relevant financial relationships.
Farhan Khalid indicated no relevant financial relationships.
Doantrang Du indicated no relevant financial relationships.
Hardikkumar Bhanderi, MD, Anosh Khan, MD, Farhan Khalid, MD, Doantrang Du, MD. P4123 - A Rare Case of Protein-Losing Enteropathy Caused by Mantle Cell Lymphoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.