Secondary Lymphedema After Intestinal Tuberculosis: A Case Report

Abstract

Lymphedema-excessive accumulation of interstitial fluid in limb tissue, primarily due to obstruction or deterioration of the lymphatic system-is classified as primary and secondary. Primary lymphedema is caused by specific etiological defects involving lymph nodes or lymphatic vessels. Secondary lymphedema involves lymphatic system damage caused by external factors, primarily cancer or cancer treatment. Lymphedema typically lowers quality of life because of pain and repeated inflammation; however, it is frequently not diagnosed appropriately. In adult patients with lymphedema without a history of cancer, only symptomatic treatment can be administered without examining the specific cause. However, to reduce complications and prevent lymphatic system deterioration, accurate diagnosis is needed. We report a case of a patient who was under long-term treatment for lymphedema of the lower extremities without improvement and was finally diagnosed with intestinal Annals of Rehabilitation Medicine

Acquired lymphedema: Molecular contributors and future directions for developing intervention strategies

“…Unlike primary lymphedema, which is a clinical manifestation of insufficient lymphatic transport, acquired lymphedema is a consequence of traumatic perturbation of the lymphatic system, mainly due to malignancy, inflammation, and infections ( Rutkowski et al, 2006 ; Padera et al, 2016 ; Borman, 2018 ; Hong et al, 2019 ; Bertelli et al, 2020 ). Acquired lymphedema constitutes more than 90% cases of lymphedema worldwide ( Greene and Goss, 2018/04 ).…”

“…Interestingly, a recent case report by Hong et al (2019) established a causative association between bacterial infection and lymphedema in the lower extremities of a patient with intestinal tuberculosis in Korea. Although an extremely rare case, it can broaden our horizon that lymphedema is not solely attributed to the adverse effects of anticancer regimens.…”

Recombinant VEGF-C (Cys156Ser) protein restores mesenteric lymphatic drainage and improves gut immune surveillance in experimental liver cirrhosis

“…Lymphangiogenesis in the gut during inflammation compensates for lymphatic insufficiency in patients with gut inflammatory diseases such as inflammatory bowel disease and Crohn's disease, where there is both an increase and redistribution of lymphatic vessels 4,5 . In liver cirrhosis, it is documented that the production of abdominal lymph increases 30-fold and there exists a positive correlation of lymph flow with increasing portal pressures 6,7 .Using animal models of CCl4-induced liver damage, an elegant study has reported that mesenteric lymphatic vessels show an impaired phenotype and reduced contractility in cirrhosis 8 .…”

“…Gut lymphatic vessels (LVs) play essential roles in the absorption and transportation of fat, maintenance of fluid homeostasis, removal of interstitial fluid, macromolecules, immune cells, and microbial debris from intestine, and returning lymph to the blood circulation, thereby preventing edema and abdominal ascites [7]. Lymphangiogenesis (proliferation of LVs from the pre-existing LVs) in the gut during inflammation compensates for lymphatic insufficiency in patients with inflammatory bowel disease (IBD), such as Crohn's disease, where there is both an increase and a redistribution of LVs [8,9]. In liver cirrhosis, the production of abdominal lymph increases 30-fold, and there is a positive correlation between lymph flow and increasing portal pressure [10,11].…”