Intestinal lymphangiectasia and bilateral pleural effusions: Effect of dietary therapy and surgical intervention on immunologic and pulmonary parameters

Lester, Lucille A.; Rothberg, Richard M.; Krantman, H J; Shermeta, Dennis W.

doi:10.1016/0091-6749(86)90236-8

Cited by 8 publications

(2 citation statements)

References 16 publications

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“…42 A low-fat, highprotein diet can help return circulating immunoglobulin concentrations to normal. 43 Infusion of IVIG successfuly reduced the rate of infection in two patients with protein-losing enteropathy. 44 Chronic renal disease.…”

Section: Diseases Of Immunoglobulin Lossmentioning

confidence: 99%

Evaluating and managing hypogammaglobulinemia.

Rose

Lang

2006

Cleveland Clinic Journal of Medicine

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Section: Diseases Of Immunoglobulin Lossmentioning

confidence: 99%

Evaluating and managing hypogammaglobulinemia.

Rose

Lang

2006

Cleveland Clinic Journal of Medicine

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“…The classical symptoms are bilateral or unilateral lower limb edema and intermittent diarrhea. Some patients develop steatorrhea; in other cases, an accumulation of fluids in body cavities resulting in pleural effusion or ascites has been reported [ 5 , 6 ]. The main patient complaints are abdominal pain, nausea and vomiting, intermittent diarrhea and steatorrhea, chronic fatigue, weakness, weight loss, and inability to gain weight.…”

Section: Introductionmentioning

confidence: 99%

Intestinal Lymphangiectasia: Insights on Management and Literature Review

et al. 2016

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Patient: Male, 24Final Diagnosis: Intestinal lymphangiectasiaSymptoms: Frequent episodes of diarrhea • recurrent infections • swelling in the lower limbsMedication: Octreotide • MCT oilsClinical Procedure: Endoscopic exam • Doppler ultrasound study • abdominal CT scanSpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Intestinal lymphangiectasia (IL) is a rare disease characterized by a dilatation of the intestinal lymphatics and loss of lymph fluid into the gastrointestinal tract leading to hypoproteinemia, edema, lymphocytopenia, hypogammaglobinemia, and immunological abnormalities. Iron, calcium, and other serum components (e.g., lipids, fat soluble vitamins) may also be depleted. A literature search revealed more than 200 reported cases of IL. Herein, we report our observations of a patient diagnosed with IL; we also present our conclusion for our review of the published literature.Case Report:A 24-year-old male was admitted to Aleppo University Hospital with the complaints of abdominal pain, headache, arthralgia, fever, and rigors. His past medical history was remarkable for frequent episodes of diarrhea, recurrent infections, and swelling in the lower limbs. In addition, he had been hospitalized several times in non-academic hospitals due to edema in his legs, cellulitis, and recurrent infections. In the emergency department, a physical examination revealed a patient in distress. He was weak, dehydrated, pale, and had a high-grade fever. His lower extremities were edematous, swollen, and extremely tender to touch. The overlying skin was erythematous and warm. Moreover, the patient was tachycardic, tacypneic, and moderately hypotensive. The patient was resuscitated with IV fluids, and Tylenol was administered to bring the temperature down. Blood tests showed anemia and high levels of inflammatory markers. The patient’s white blood cell count was elevated with an obvious left shift. However, subsequent investigations showed that the patient had IL. Suitable diet modification plans were applied as a long-term management plan.Conclusions:IL is a rare disease of challenging nature due to its systematic effects and lack of comprehensive studies that can evaluate the effectiveness of specific treatments in a large cohort of patients. Medium-chain triglyceride (MCT) oils and diet modification strategies are effective in reducing the loss of body proteins and in maintaining near-normal blood levels of immunoglobulins. However, octreotide and MCT oils had no proven role in reducing lymphedema in our patient.

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