Nodular lymphoid hyperplasia by<i>Giardia lamblia</i>

Pérez-Roldán, Francisco; Mate-Valdezate, A.; Villafáñez-García, M. C.; Carro, Pedro González; Huidobro, María Luisa Legaz

doi:10.1055/s-2007-995398

Cited by 7 publications

(3 citation statements)

References 2 publications

(3 reference statements)

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“…PCR of the reviewed samples would be needed to give an exact number of those patients who were norovirus positive at the time of sampling. Both patients with recurrent Giardia infections had lymphoid hyperplasia as described by Webster et al and Pérez-Roldan [ 20 , 54 ].…”

Section: Discussionmentioning

confidence: 93%

Bowel Histology of CVID Patients Reveals Distinct Patterns of Mucosal Inflammation

et al. 2021

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Diarrhea is the commonest gastrointestinal symptom in patients with common variable immunodeficiency (CVID). Different pathologies in patients’ bowel biopsies have been described and links with infections have been demonstrated. The aim of this study was to analyze the bowel histology of CVID patients in the Royal-Free-Hospital (RFH) London CVID cohort. Ninety-five bowel histology samples from 44 adult CVID patients were reviewed and grouped by histological patterns. Reasons for endoscopy and possible causative infections were recorded. Lymphocyte phenotyping results were compared between patients with different histological features. There was no distinctive feature that occurred in most diarrhea patients. Out of 44 patients (95 biopsies), 38 lacked plasma cells. In 14 of 21 patients with nodular lymphoid hyperplasia (NLH), this was the only visible pathology. In two patients, an infection with Giardia lamblia was associated with NLH. An IBD-like picture was seen in two patients. A coeliac-like picture was found in six patients, four of these had norovirus. NLH as well as inflammation often occurred as single features. There was no difference in blood lymphocyte phenotyping results comparing groups of histological features. We suggest that bowel histology in CVID patients with abdominal symptoms falls into three major histological patterns: (i) a coeliac-like histology, (ii) IBD-like changes, and (iii) NLH. Most patients, but remarkably not all, lacked plasma cells. CVID patients with diarrhea may have an altered bowel histology due to poorly understood and likely diverse immune-mediated mechanisms, occasionally driven by infections.

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Section: Discussionmentioning

confidence: 93%

Bowel Histology of CVID Patients Reveals Distinct Patterns of Mucosal Inflammation

et al. 2021

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“…The low serum protein was most likely due to an exudative enteropathy caused by giardiasis-induced mucosal inflammation. Likewise, the patient’s retroperitoneal lymphadenopathy and B symptoms were most likely the result of the local inflammatory reaction [ 11 ]. The clinical suspicion of lymphoma prompted us to perform PET/CT imaging before standard GI tract endoscopic examination.…”

Section: Discussionmentioning

confidence: 99%

An exotic cause of exudative enteropathy

Tsourdi¹,

Heidrich

Winzer³

et al. 2014

Am J Case Rep

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Patient: Male, 50Final Diagnosis: Exudative enteropathySymptoms: Abdominal pain • diarrhea • fever • hyponatremia • lymphadenopathy • weight lossMedication: —Clinical Procedure: —Specialty: —Objective:Unusual clinical courseBackground:Protein-losing enteropathy is a rare cause of hypoproteinemia. Erosive and non-erosive gastrointestinal diseases as well as vascular disorders that result in increased central venous pressure or mesenteric lymphatic obstruction may result in protein loss via the gastrointestinal tract.Case Report:We present the case of a 50-year-old man with protein-losing enteropathy, who had profuse diarrhea, abdominal pain, lymphadenopathy, fever, and a weight loss of 10 kg in the preceding 2 months. Extensive work-up revealed infection with Giardia lamblia. We review clinical signs and symptoms, laboratory findings, and imaging studies, and discuss potential pitfalls in establishing the diagnosis.Conclusions:To the best of our knowledge, this represents one of the few published cases of intestinal giardiasis as a cause of protein-losing enteropathy in an immunocompetent adult. The diagnosis of lambliasis should be based on a combination of stool cultures and serum serology, and in cases of high clinical suspicion, an endoscopy and biopsy of the upper GI tract is recommended.

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“…Hyperimmunoglobulin M also can be associated with chronic diarrhea. Both Cryptosporidium and Giardia rarely cause nodularity of the small intestine (4); however, no etiologic microorganism was identified on stool testing. Therefore, given the histologic picture a showing high number of mastocytes, we presume that the symptoms and the nodular mucosal changes were caused by systemic mastocytosis.…”

Section: Figurementioning

confidence: 99%

Nodularity of the Small Intestine in a Child With Systemic Mastocytosis Associated With Hyperimmunoglobulin M Syndrome

Homan¹,

Avčin²

2011

J. pediatr. gastroenterol. nutr.

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A 7-year-old boy with hyperimmunoglobulin M syndrome presented with intermittent bloody diarrhea since the age of 6 months. On physical examination he had hepatosplenomegaly, generalized lympadenopathy, and hyperpigmented papular/vesicular rash around the umbilicus. The growth parameters were normal. The skin biopsy was consistent with mastocytoma. Endoscopic evaluation revealed nodular small intestinal mucosa. The most prominent nodularity was seen in the duodenum (Fig. 1), and less so in the terminal ileum. The histology revealed acute and chronic inflammation without architectural changes, and a high number of mastocytes, confirming systemic mastocytosis (Fig. 2). Treatment with monthly intravenous gamma globulin, antihistamines, ketotifen, and proton pump inhibitor resulted in almost complete resolution of gastrointestinal symptoms.Mastocytosis is characterized by excessive proliferation of mastocytes in several organs, most frequently skin, bones, lymph nodes, liver, spleen, and the gastrointestinal tract (1). Systemic mastocytosis is rare in children (2). Therapy is based on symptomatic treatment and avoiding triggers of mast cell mediator release. Long-term prognosis for pediatric-onset disease is better in contrast to adult-onset mastocytosis (3). Hyperimmunoglobulin M also can be associated with chronic diarrhea. Both Cryptosporidium and Giardia rarely cause nodularity of the small intestine (4); however, no etiologic microorganism was identified on stool testing. Therefore, given the histologic picture a showing high number of mastocytes, we presume that the symptoms and the nodular mucosal changes were caused by systemic mastocytosis.

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Nodular lymphoid hyperplasia byGiardia lamblia

Cited by 7 publications

References 2 publications

Bowel Histology of CVID Patients Reveals Distinct Patterns of Mucosal Inflammation

Bowel Histology of CVID Patients Reveals Distinct Patterns of Mucosal Inflammation

An exotic cause of exudative enteropathy

Nodularity of the Small Intestine in a Child With Systemic Mastocytosis Associated With Hyperimmunoglobulin M Syndrome

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