2017-05-16 13:30:28 UTC

A Unique Cause of Persistent Diarrhea

May 16, 2017

This Gastroenterology image challenge highlights the case of a 60-year-old man with a history of intermittent diarrhea now experiencing approximately five episodes a day.

Gastroenterology Clinical Image Challenge: A 60-year-old man with a five-year history of intermittent diarrhea had been experiencing approximately five episodes a day when he visited the hospital. The diarrhea was watery, and he had no abdominal pain, but slight edema was noted in his lower legs. Blood test results revealed decreased albumin level of 1.5 g/dL, normal C-reactive protein level, and increased serum-soluble interleukin-2 receptor (sIL-2R) level of 1443 U/mL. Upper GI endoscopy revealed many small white nodules throughout the esophagus (Figure A), and the duodenal mucous membrane was edematous and rough (Figure B). On lower GI endoscopy, small white erosions were found throughout the colon (Figure C, narrow-band imaging), and the rectal mucous membrane was edematous (Figure D), although no abnormality was found in the terminal ileum.

What is the diagnosis?

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