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Case report
Primary intestinal lymphangiectasia diagnosed by video capsule endoscopy in a patient with immunodeficiency presenting with Morganella morganii bacteraemia
  1. John M Cunningham1,2,
  2. Sansrita Nepal1,2 and
  3. Aimee E Truesdale3,4
  1. 1Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA
  2. 2Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  3. 3Division of Gastroenterology and Hepatology, Denver Health and Hospital Authority, Denver, Colorado, USA
  4. 4Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  1. Correspondence to Dr John M Cunningham; john.cunningham{at}cuanschutz.edu

Abstract

A 24-year-old woman with a medical history of chronic lower extremity oedema, abdominal pain, diarrhoea and recurrent pulmonary infections presented with sepsis from right lower extremity cellulitis. Blood cultures grew Morganella morganii. Laboratory evaluation revealed lymphopaenia, hypogammaglobulinaemia, a low CD4+ T-cell count and nutritional deficiencies resulting from protein-losing enteropathy (PLE). CT showed small bowel wall thickening in the jejunum and ileum. Primary intestinal lymphangiectasia (PIL) was the likely diagnosis that explained her PLE and immunodeficiencies. Video capsule endoscopy is an important diagnostic tool for distal small bowel pathology and confirmed patchy areas of lymphangiectasia of the jejunum and ileum. Secondary causes of lymphangiectasia were ruled out. Clinically significant immunodeficiency from PIL has not been frequently documented, and this case adds to the literature of rare infections associated with PIL. Treatment with intravenous antibiotics resolved her septicaemia, while dietary modifications improved her oedema, abdominal pain and diarrhoea.

  • endoscopy
  • malabsorption
  • general practice / family medicine
  • infectious diseases
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Footnotes

  • Contributors All three authors cared for the patient and contributed to the manuscript. JMC and SN conducted a literature review and manuscript write-up. AET performed the endoscopy, provided clinical images and figure legends, and helped revise the manuscript critically for important intellectual content. All authors gave their final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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