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CASE REPORT

Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report

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Vasile Daniel Balaban1,2, Alina Popp2,3,4, Mugur Grasu5, Florina Vasilescu1, Mariana Jinga1,2

1) Dr. Carol Davila Central Military Emergency University Hospital;
2) Carol Davila University of Medicine and Pharmacy;
3) Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania
4) Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland
5) Fundeni Clinical Institute, Bucharest, Romania

http://dx.doi.org/10.15403/jgld.2014.1121.243.bal

ABSTRACT


Background:
Primary intestinal lymphangiectasia (Waldmann’s disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia.

Case presentation: We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy.

Conclusions:
Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.

Key words: intestinal lymphangiectasia – anemia – refractory – antiplasmin.