Primary Intestinal Lymphangiectasia: Is It Always Bad? Two Cases with Different Outcome
Identifieur interne : 002135 ( Pmc/Curation ); précédent : 002134; suivant : 002136Primary Intestinal Lymphangiectasia: Is It Always Bad? Two Cases with Different Outcome
Auteurs : Ioannis Xinias [Grèce] ; Antigoni Mavroudi [Grèce] ; Evi Sapountzi [Grèce] ; Agathi Thomaidou [Grèce] ; Maria Fotoulaki [Grèce] ; Athanasios Kalambakas [Grèce] ; Elina Karypidou [Grèce] ; Konstantinos Kollios [Grèce] ; Grigorios Pardalos [Grèce] ; George Imvrios [Grèce]Source :
- Case Reports in Gastroenterology [ 1662-0631 ] ; 2013.
Abstract
Primary intestinal lymphangiectasia (PIL) or Waldmann's disease is a rare protein-losing gastroenteropathy of unknown etiology. Less than 200 cases have been reported globally. Patients may be asymptomatic or present edema, lymphedema, diarrhea, ascites and other manifestations. We report two pediatric cases with PIL with extremely different outcome in a 3-year follow-up period. The first patient presented with persistent diarrhea, hypoalbuminemia and failure to thrive, while the second patient presented with an abrupt eyelid edema. Hypoproteinemia was the common laboratory finding for the two patients and upper gastrointestinal endoscopy established the diagnosis. The first patient relapsed five times during the follow-up period after the diagnosis had been made and required intravenous albumin administration and micronutrient supplementation. The second patient revealed normal gastrointestinal endoscopy 4 months after the diagnosis had been established; he followed an unrestricted diet and remained asymptomatic throughout the follow-up period. PIL can be either severe, affecting the entire small bowel, leading to lifetime disease, or sometimes affects part of the small bowel, leading to transient disorder.
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DOI: 10.1159/000348763
PubMed: 23626516
PubMed Central: 3617964
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Two Cases with Different Outcome</title><author><name sortKey="Xinias, Ioannis" sort="Xinias, Ioannis" uniqKey="Xinias I" first="Ioannis" last="Xinias">Ioannis Xinias</name><affiliation wicri:level="1"><nlm:aff id="aff1">Third Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Third Pediatric Department, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Mavroudi, Antigoni" sort="Mavroudi, Antigoni" uniqKey="Mavroudi A" first="Antigoni" last="Mavroudi">Antigoni Mavroudi</name><affiliation wicri:level="1"><nlm:aff id="aff1">Third Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Third Pediatric Department, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Sapountzi, Evi" sort="Sapountzi, Evi" uniqKey="Sapountzi E" first="Evi" last="Sapountzi">Evi Sapountzi</name><affiliation wicri:level="1"><nlm:aff id="aff3">First Pediatric Department, Hippocration Hospital, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>First Pediatric Department, Hippocration Hospital, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Thomaidou, Agathi" sort="Thomaidou, Agathi" uniqKey="Thomaidou A" first="Agathi" last="Thomaidou">Agathi Thomaidou</name><affiliation wicri:level="1"><nlm:aff id="aff1">Third Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Third Pediatric Department, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Fotoulaki, Maria" sort="Fotoulaki, Maria" uniqKey="Fotoulaki M" first="Maria" last="Fotoulaki">Maria Fotoulaki</name><affiliation wicri:level="1"><nlm:aff id="aff4">Fourth Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Fourth Pediatric Department, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Kalambakas, Athanasios" sort="Kalambakas, Athanasios" uniqKey="Kalambakas A" first="Athanasios" last="Kalambakas">Athanasios Kalambakas</name><affiliation wicri:level="1"><nlm:aff id="aff5">Gastroenterology Department, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Gastroenterology Department, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Karypidou, Elina" sort="Karypidou, Elina" uniqKey="Karypidou E" first="Elina" last="Karypidou">Elina Karypidou</name><affiliation wicri:level="1"><nlm:aff id="aff1">Third Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Third Pediatric Department, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Kollios, Konstantinos" sort="Kollios, Konstantinos" uniqKey="Kollios K" first="Konstantinos" last="Kollios">Konstantinos Kollios</name><affiliation wicri:level="1"><nlm:aff id="aff1">Third Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Third Pediatric Department, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Pardalos, Grigorios" sort="Pardalos, Grigorios" uniqKey="Pardalos G" first="Grigorios" last="Pardalos">Grigorios Pardalos</name><affiliation wicri:level="1"><nlm:aff id="aff3">First Pediatric Department, Hippocration Hospital, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>First Pediatric Department, Hippocration Hospital, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author><author><name sortKey="Imvrios, George" sort="Imvrios, George" uniqKey="Imvrios G" first="George" last="Imvrios">George Imvrios</name><affiliation wicri:level="1"><nlm:aff id="aff2">Transplantation and Surgery Clinic, Papageorgiou Hospital, Thessaloniki, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Transplantation and Surgery Clinic, Papageorgiou Hospital, Thessaloniki</wicri:regionArea></affiliation></author></analytic><series><title level="j">Case Reports in Gastroenterology</title><idno type="eISSN">1662-0631</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Primary intestinal lymphangiectasia (PIL) or Waldmann's disease is a rare protein-losing gastroenteropathy of unknown etiology. Less than 200 cases have been reported globally. Patients may be asymptomatic or present edema, lymphedema, diarrhea, ascites and other manifestations. We report two pediatric cases with PIL with extremely different outcome in a 3-year follow-up period. The first patient presented with persistent diarrhea, hypoalbuminemia and failure to thrive, while the second patient presented with an abrupt eyelid edema. Hypoproteinemia was the common laboratory finding for the two patients and upper gastrointestinal endoscopy established the diagnosis. The first patient relapsed five times during the follow-up period after the diagnosis had been made and required intravenous albumin administration and micronutrient supplementation. The second patient revealed normal gastrointestinal endoscopy 4 months after the diagnosis had been established; he followed an unrestricted diet and remained asymptomatic throughout the follow-up period. PIL can be either severe, affecting the entire small bowel, leading to lifetime disease, or sometimes affects part of the small bowel, leading to transient disorder.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Vignes, S" uniqKey="Vignes S">S Vignes</name></author><author><name sortKey="Bellanger, J" uniqKey="Bellanger J">J Bellanger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, J" uniqKey="Lee J">J Lee</name></author><author><name sortKey="Kong, Ms" uniqKey="Kong M">MS Kong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liu, Nf" uniqKey="Liu N">NF Liu</name></author><author><name sortKey="Lu, Q" uniqKey="Lu Q">Q Lu</name></author><author><name sortKey="Wang, Cg" uniqKey="Wang C">CG Wang</name></author><author><name sortKey="Zhou, Jg" uniqKey="Zhou J">JG Zhou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wen, J" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Gastroenterol</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Gastroenterol</journal-id><journal-id journal-id-type="publisher-id">CRG</journal-id><journal-title-group><journal-title>Case Reports in Gastroenterology</journal-title></journal-title-group><issn pub-type="epub">1662-0631</issn><publisher><publisher-name>S. Karger AG</publisher-name><publisher-loc>Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23626516</article-id><article-id pub-id-type="pmc">3617964</article-id><article-id pub-id-type="doi">10.1159/000348763</article-id><article-id pub-id-type="publisher-id">crg-0007-0153</article-id><article-categories><subj-group subj-group-type="heading"><subject>Published online: March, 2013</subject></subj-group></article-categories><title-group><article-title>Primary Intestinal Lymphangiectasia: Is It Always Bad? Two Cases with Different Outcome</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Xinias</surname><given-names>Ioannis</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Mavroudi</surname><given-names>Antigoni</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sapountzi</surname><given-names>Evi</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Thomaidou</surname><given-names>Agathi</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fotoulaki</surname><given-names>Maria</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kalambakas</surname><given-names>Athanasios</given-names></name><xref ref-type="aff" rid="aff5"><sup>e</sup></xref></contrib><contrib contrib-type="author"><name><surname>Karypidou</surname><given-names>Elina</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kollios</surname><given-names>Konstantinos</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pardalos</surname><given-names>Grigorios</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Imvrios</surname><given-names>George</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib></contrib-group><aff id="aff1"><sup>a</sup>Third Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</aff><aff id="aff2"><sup>b</sup>Transplantation and Surgery Clinic, Papageorgiou Hospital, Thessaloniki, Greece</aff><aff id="aff3"><sup>c</sup>First Pediatric Department, Hippocration Hospital, Papageorgiou Hospital, Thessaloniki, Greece</aff><aff id="aff4"><sup>d</sup>Fourth Pediatric Department, Papageorgiou Hospital, Thessaloniki, Greece</aff><aff id="aff5"><sup>e</sup>Gastroenterology Department, Papageorgiou Hospital, Thessaloniki, Greece</aff><author-notes><corresp id="cor1">*Dr. Ioannis Xinias, MD, PhD, Protomagias 62, GR-54352 Thessaloniki (Greece), E-Mail <email>xinias@auth.gr</email></corresp></author-notes><pub-date pub-type="collection"><season>Jan-Apr</season><year>2013</year></pub-date><pub-date pub-type="epub"><day>20</day><month>3</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>3</month><year>2013</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>7</volume><issue>1</issue><fpage>153</fpage><lpage>163</lpage><permissions><copyright-statement>Copyright © 2013 by S. Karger AG, Basel</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/">http://creativecommons.org/licenses/by-nc-nd/3.0/</ext-link>). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on <ext-link ext-link-type="uri" xlink:href="http://www.karger.com">http://www.karger.com</ext-link> and the terms of this license are included in any shared versions.</license-p></license></permissions><abstract><p>Primary intestinal lymphangiectasia (PIL) or Waldmann's disease is a rare protein-losing gastroenteropathy of unknown etiology. Less than 200 cases have been reported globally. Patients may be asymptomatic or present edema, lymphedema, diarrhea, ascites and other manifestations. We report two pediatric cases with PIL with extremely different outcome in a 3-year follow-up period. The first patient presented with persistent diarrhea, hypoalbuminemia and failure to thrive, while the second patient presented with an abrupt eyelid edema. Hypoproteinemia was the common laboratory finding for the two patients and upper gastrointestinal endoscopy established the diagnosis. The first patient relapsed five times during the follow-up period after the diagnosis had been made and required intravenous albumin administration and micronutrient supplementation. The second patient revealed normal gastrointestinal endoscopy 4 months after the diagnosis had been established; he followed an unrestricted diet and remained asymptomatic throughout the follow-up period. PIL can be either severe, affecting the entire small bowel, leading to lifetime disease, or sometimes affects part of the small bowel, leading to transient disorder.</p></abstract><kwd-group><title>Key words</title><kwd>Protein-losing enteropathy</kwd><kwd>Children</kwd><kwd>Primary intestinal lymphangiectasia</kwd><kwd>Wireless capsule endoscopy</kwd><kwd>Outcome</kwd></kwd-group><counts><fig-count count="6"></fig-count><table-count count="2"></table-count><ref-count count="17"></ref-count><page-count count="11"></page-count></counts></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><p>Case 1. Upper GI endoscopy showing D1 covered with white smear (black arrows). D2 appears with edematous intestinal mucosa covered with areas of white exudate (white arrows).</p></caption><graphic xlink:href="crg-0007-0153-g01"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><p>Case 1. Wireless capsule endoscopy showing white spot lesions on the entire duodenal mucosa (arrows).</p></caption><graphic xlink:href="crg-0007-0153-g02"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><p>Case 1. Wireless capsule endoscopy showing white spot lesions in the jejunum (arrows).</p></caption><graphic xlink:href="crg-0007-0153-g03"></graphic></fig><fig id="F4" orientation="portrait" position="float"><label>Fig. 4</label><caption><p>Case 1. Wireless capsule endoscopy showing very dense white lesions in the ileum (black arrows) to the ileocecal valve area (white arrows).</p></caption><graphic xlink:href="crg-0007-0153-g04"></graphic></fig><fig id="F5" orientation="portrait" position="float"><label>Fig. 5</label><caption><p>Case 2. Upper GI endoscopy showing increased lymph diffusion through ruptured lymph vessels appearing as white spots on the duodenal mucosa (arrows).</p></caption><graphic xlink:href="crg-0007-0153-g05"></graphic></fig><fig id="F6" orientation="portrait" position="float"><label>Fig. 6</label><caption><p>Case 2. Capsule endoscopy showing white spot lesions in a PIL-affected part of the jejunum.</p></caption><graphic xlink:href="crg-0007-0153-g06"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Laboratory investigation in case 1</p></caption><table frame="hsides" rules="groups"><tbody><tr valign="top"><td align="left" rowspan="1" colspan="1">White blood cells</td><td rowspan="1" colspan="1"></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Absolute count/mm<sup>3</sup></td><td align="left" rowspan="1" colspan="1">10,800</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Polymorphonuclear cells</td><td align="left" rowspan="1" colspan="1">56.6%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Lymphocytes</td><td align="left" rowspan="1" colspan="1">19.0%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Monocytes</td><td align="left" rowspan="1" colspan="1">13.8%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Eosinophils</td><td align="left" rowspan="1" colspan="1">12.8%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Coagulation tests (PT, PTT)</td><td align="left" rowspan="1" colspan="1">normal (PT 11.3 s, PTT 34.5 s)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Sweat test</td><td align="left" rowspan="1" colspan="1">normal (sweat chloride level 21 mmol/l)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Stool cultures for Salmonella, Shigella, Yersinia, Campylobacter, <italic>Clostridium difficile</italic> toxin</td><td align="left" rowspan="1" colspan="1">negative</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Stool microscopic examination for common parasites, fat, muscle fibers</td><td align="left" rowspan="1" colspan="1">negative</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Blood biochemistry</td><td rowspan="1" colspan="1"></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Total serum protein</td><td align="left" rowspan="1" colspan="1">2.7 g/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Albumin</td><td align="left" rowspan="1" colspan="1">1.5 g/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Creatinine</td><td align="left" rowspan="1" colspan="1">0.57 mg/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> SGOT</td><td align="left" rowspan="1" colspan="1">35 U/ml</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> SGPT</td><td align="left" rowspan="1" colspan="1">18 U/ml</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Calcium</td><td align="left" rowspan="1" colspan="1">7.2 mg/dl (normal: 7.6–10.8 mg/dl)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Phosphorus</td><td align="left" rowspan="1" colspan="1">4.4 mg/dl</td></tr><tr valign="top"><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"><italic>Immunological investigation</italic></td><td rowspan="1" colspan="1"></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Widal & Wright reactions</td><td align="left" rowspan="1" colspan="1">negative</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">IgA anti-tissue transglutaminase antibodies</td><td align="left" rowspan="1" colspan="1">0.35 U/ml (normal: <7.0)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">C-reactive protein</td><td align="left" rowspan="1" colspan="1">negative (3.0 mg/l)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Antibody serum levels against rotavirus, adenovirus, parvovirus, Coxsackievirus, EBV, CMV, HIV</td><td align="left" rowspan="1" colspan="1">normal</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">IgG</td><td align="left" rowspan="1" colspan="1">1.21 g/l (normal: 5.30–11)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">IgM</td><td align="left" rowspan="1" colspan="1">0.278 g/l (normal: 0.64–1.95)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Immunophenotyping</td><td align="left" rowspan="1" colspan="1">Reduced T-lymphocytes:
<list list-type="simple"><list-item><p>CD3: 43% (normal: 56–80%)</p></list-item><list-item><p>CD4: 16% (normal: 31–64%)</p></list-item><list-item><p>CD29: 11% (normal: 15–50%)</p></list-item><list-item><p>CD45RA: 6.5% (normal: 15–60%)</p></list-item></list></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">ANA, antigliadin antibodies, antiendomysium antibodies, antireticulin antibodies</td><td align="left" rowspan="1" colspan="1">negative</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Total serum IgE</td><td align="left" rowspan="1" colspan="1">783 IU/ml (normal: <100 IU/ml)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Specific IgE</td><td align="left" rowspan="1" colspan="1">normal values: <0.35 IU/ml
<list list-type="simple"><list-item><p>α-lactalbumin: 2.1 IU/ml</p></list-item><list-item><p>β-lactoglobulin: 1.1 IU/ml</p></list-item><list-item><p>casein: 0.87 IU/ml</p></list-item><list-item><p>beef: 1.1 IU/ml</p></list-item><list-item><p>total milk: <0.10 IU/ml</p></list-item></list></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Zinc (serum)</td><td align="left" rowspan="1" colspan="1">6.9 μmol/l (normal: 9.8–18.1 μmol/l)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Vitamin D<sub>3</sub> 25 hydroxy (plasma)</td><td align="left" rowspan="1" colspan="1">7.4 ng/ml (normal: 14–42 ng/ml)</td></tr></tbody></table></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Laboratory investigation in case 2</p></caption><table frame="hsides" rules="groups"><tbody><tr valign="top"><td align="left" rowspan="1" colspan="1">Full blood count</td><td rowspan="1" colspan="1"></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Leukocytes/mm<sup>3</sup></td><td align="left" rowspan="1" colspan="1">10,100</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Polymorphonuclear cells</td><td align="left" rowspan="1" colspan="1">66%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Lymphocytes</td><td align="left" rowspan="1" colspan="1">23%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Monocytes</td><td align="left" rowspan="1" colspan="1">8%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Eosinophils</td><td align="left" rowspan="1" colspan="1">3%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Hgb</td><td align="left" rowspan="1" colspan="1">11.8 g/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Hct</td><td align="left" rowspan="1" colspan="1">33%</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Platelets/mm<sup>3</sup></td><td align="left" rowspan="1" colspan="1">212,000</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">ESR</td><td align="left" rowspan="1" colspan="1">normal (8 mm in the 1st hour)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Prothrombin time</td><td align="left" rowspan="1" colspan="1">normal (11.1 s)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Activated partial thromboplastin time</td><td align="left" rowspan="1" colspan="1">normal (34 s)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Blood biochemistry</td><td rowspan="1" colspan="1"></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Total serum protein</td><td align="left" rowspan="1" colspan="1">3.1 g/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Albumin</td><td align="left" rowspan="1" colspan="1">2.1 g/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> SGOT</td><td align="left" rowspan="1" colspan="1">32 U/l</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> SGPT</td><td align="left" rowspan="1" colspan="1">18 U/l</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Urea</td><td align="left" rowspan="1" colspan="1">21 mg/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Creatinine</td><td align="left" rowspan="1" colspan="1">0.42 mg/dl</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Na</td><td align="left" rowspan="1" colspan="1">138 mEq/l</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> K</td><td align="left" rowspan="1" colspan="1">3.9 mEq/l</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"> Total (direct) bilirubin</td><td align="left" rowspan="1" colspan="1">0.2 mg/dl (direct: 0.03 mg/dl)</td></tr><tr valign="top"><td align="left" colspan="2" rowspan="1"><hr></hr></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1"><italic>Immunological investigation</italic></td><td rowspan="1" colspan="1"></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Antibody serum levels against rotavirus, adenovirus, parvovirus, Coxsackievirus, EBV, CMV, HIV</td><td align="left" rowspan="1" colspan="1">normal</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">C-reactive protein</td><td align="left" rowspan="1" colspan="1">negative (2.1 mg/l)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Widal & Wright reactions</td><td align="left" rowspan="1" colspan="1">negative</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">IgA anti-tissue transglutaminase antibodies</td><td align="left" rowspan="1" colspan="1">1.30 U/ml (normal: <7.0)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">IgG</td><td align="left" rowspan="1" colspan="1">2.28 g/l (normal: 5.30–11)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">IgM</td><td align="left" rowspan="1" colspan="1">0.406 g/l (normal: 0.64–1.95)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">ANA, antigliadin antibodies, antiendomysium antibodies, antireticulin antibodies</td><td align="left" rowspan="1" colspan="1">negative</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Total serum IgE</td><td align="left" rowspan="1" colspan="1">45 IU/ml (normal: <100)</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">α-Lactalbumin, β-lactoglobulin, casein, total milk-specific IgE</td><td align="left" rowspan="1" colspan="1">normal values: <0.35 IU/ml
<list list-type="simple"><list-item><p>α-lactalbumin: <0.10 IU/ml</p></list-item><list-item><p>β-lactoglobulin: <0.10 IU/ml</p></list-item><list-item><p>casein: <0.10 IU/ml</p></list-item><list-item><p>total milk: <0.10 IU/l</p></list-item><list-item><p>beef: <0.10 IU/ml</p></list-item></list></td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Fecal microscopic examination for common parasites, fat, muscle fibers and stool cultures</td><td align="left" rowspan="1" colspan="1">negative</td></tr><tr valign="top"><td align="left" rowspan="1" colspan="1">Protein electrophoresis</td><td align="left" rowspan="1" colspan="1">α<sub>1</sub>-globulins: 0.45 g/dl (normal: 0.2–0.3 g/dl)</td></tr><tr valign="top"><td rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">α<sub>2</sub>-globulins: 1.6 g/dl (normal: 0.4–1.0 g/dl)</td></tr><tr valign="top"><td rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">γ-globulins: 0.25 g/dl (normal: 0.7–1.2 g/dl)</td></tr><tr valign="top"><td rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">β-globulins: 0.65 g/dl (normal: 0.5–1.1 g/dl)</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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