Diagnosis and endoscopic intervention in rare MALT lymphoma of the proximal jejunum

2021 ◽  
Vol 75 (5) ◽  
pp. 432-437
Author(s):  
Tomáš Drašar ◽  
Lenka Nedbalová ◽  
Tomáš Zajíc ◽  
Tomáš Jirásek
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Malt Lymphoma ◽  
Marginal Zone ◽  
Proximal Jejunum ◽  
Endoscopic Dilatation ◽  
Upper Endoscopy ◽  
Hodgkin's Lymphomas

Summary: Extranodal lymphoma from the marginal zone mucosa-associated lymphoid tissue (MALT lymphoma) is one of the primary extranodal non-Hodgkin‘s lymphomas with low degrees of malignancy but with the risk of spreading to distant locations in the body. B-lymphomas are sometimes associated with other diseases (eg. Helicobacter pylori and Campylobacter jejuni infections or inflammatory bowel disease). B-lymphomas may manifest with a variety of clinical signs, from dyspeptic syndrome with malabsorption and weight loss to ileus or massive gastrointestinal bleeding. Dia­gnosis is based on the clinical condition and the results of laboratory tests and imaging techniques, while endoscopy is the essential procedure for visualizing the tumor mass and collecting a bio­psy sample to determine the definitive histopathological dia­gnosis. MALT lymphoma treatment is managed by oncologists and includes chemotherapy and/or radiotherapy, with resection indicated in rare cases. In this case report we present an elderly female patient who was referred to our IBD centre for non-specific abdominal pain with a positive fecal occult blood test. Computed tomography (CT) examination was used before endoscopy and showed an infiltration of the splenic flexure by an unspecified mass, a subsequent colonoscopy showed intact mucosa of the colon, including the terminal ileum. In the second reading of the CT scan the location of the infiltrate was identified more specifically as the area of the proximal jejunum and jejunal mesentery. Subsequent upper endoscopy revealed a stenosing exulcerated tumor in the proximal jejunum, with the stenosis impassable even for a pediatric colonoscope. The dia­gnosis of MALT lymphoma was confirmed by a histological examination of the bio­psied tissue. A follow-up upper endoscopy was performed after the patient had completed her oncological treatment (chemotherapy in combination with radiotherapy), showing the presence of stenosis at the proximal jejunum, still impassable for the endoscope. In clinical terms, the patient experienced weight loss, which was to some extent caused by intermittent pseudo-obstruction when on a solid diet, therefore we decided to enrich her oral intake with high-calorie sip feed. The next follow-up CT scan of the abdomen showed a regression of the infiltrate, but the stenosis of the proximal jejunum, about 7 centimeters long, persisted. To respect the patient‘s wishes, no surgical resection of the stenotic section of the intestine was performed, but we proceeded with endoscopic dilatation of the stenotic section of the jejunum with a balloon. After the first two endoscopic dilatations of the stenotic area the patient experienced a temporary improvement in solid food tolerance. Because of restenosis, a third endoscopic dilatation was performed, with the development of complications that included short-term circulatory instability with abdominal pain and eventually required an urgent surgical solution. Key words: marginal zone B-cell lymphoma – stenosis – dilatation – intestinal perforation – jejunum – MALT

MALT Lymphomas

Hematology ◽  
2001 ◽  
Vol 2001 (1) ◽  
pp. 241-258 ◽  
Author(s):  
Franco Cavalli ◽  
Peter G. Isaacson ◽  
Randy D. Gascoyne ◽  
Emanuele Zucca
Keyword(s):  
Malt Lymphoma ◽  
Marginal Zone ◽  
Molecular Genetic ◽  
Gastric Lymphoma ◽  
Biological Properties ◽  
General Term ◽  
Gastric Malt Lymphoma ◽  
Apoptotic Pathway ◽  
Lymphoma Study Group ◽  
Hodgkin's Lymphomas

Abstract This review addresses the biology and the treatment of lymphomas arising from mucosa-associated lymphoid tissue (MALT). This entity, first described in 1983, represents about 8% of all non-Hodgkin's lymphomas and was recently re-classified as “extranodal marginal zone lymphomas of MALT-type.” The term marginal zone lymphoma (MZL) encompasses the three closely related lymphoma subtypes of nodal, primary splenic and extranodal lymphomas of MALT type: the latter represent the vast majority of MZL. These lymphomas arise at different anatomic sites, are composed of mature B-cells lacking expression of CD5 and CD10, often present with overlapping morphologic features, but typically quite distinct clinical behaviors. Only very recently cytogenetic/molecular genetic observations have underlined the distinctiveness of these three lymphoid neoplasms, which in both the R.E.A.L. and WHO-classifications are included in the general term of MZL. MALT lymphomas arise in numerous extranodal sites, but gastric MALT lymphoma is the most common and best studied and is, therefore, the paradigm for the group as a whole. Dr. Isaacson describes the principal histological features of these lymphomas, including criteria to distinguish this entity from other small B-cell lymphomas. Several lines of evidence suggest that gastric lymphoma arises from MALT acquired as the result of aH. pyloriinfection. However, at least 1/3 of cases do not respond to eradication ofH. pylori. Very recent data suggest that both t(11;18) (q21;q21) and bcl10 nuclear expression are associated with failure to respond to this treatment. Dr. Gascoyne discusses the biologic function of proteins deregulated through the different translocations, which play a role in pathogenesis of MALT lymphomas, emphasizing particularly their influence in disrupting the apoptotic pathway. Dr. Zucca reviews findings suggesting that MALT lymphoma is an antigen driven neoplasm. He also presents specific guidelines for treatment of gastric lymphomas trying to shed some light on the amazingly inconsistent and confusing data in the literature. Taking advantage on the more than 300 non-gastric MALT lymphomas collected by the International Extranodal Lymphoma Study Group (ILESG), Dr. Cavalli compares gastric lymphomas with those arising in many other sites. Overall, the data presented in this session will underline the fact, that MALT lymphomas are characterized by some unique biological properties.

scholarly journals Clinical relevance of endoscopically identified extrinsic compression of the oesophagus and stomach

2019 ◽  
Vol 6 (1) ◽  
pp. e000310
Author(s):  
Kishore Kumar ◽  
Harish Patel ◽  
Shehriyar Mehershahi ◽  
Hassan Tariq ◽  
Mariela Glandt ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Weight Loss ◽  
Ct Scan ◽  
Malignant Lesion ◽  
Gastrointestinal Symptoms ◽  
Gastric Body ◽  
Upper Endoscopy ◽  
Abnormal Finding ◽  
Extrinsic Compression ◽  
Upper Gastrointestinal

BackgroundVarious degree of extrinsic compression of the oesophagus and stomach are experienced during upper endoscopy. However, its utility in clinical practice has not been studied.MethodsElectronic chart review of all upper gastrointestinal endoscopies done at our hospital between 2005 and 2016 was performed. A total of 79 patients with documented extrinsic compression on upper gastrointestinal procedure report who had a preceding or subsequent abdomen/chest CT imaging performed within 6 months were included.Results30 (38%) out of 79 patients had abnormal finding on CT scan. 14 (47%) out of 30 patients had an associated malignant lesion, whereas remaining had a benign lesion. Overall, patients with associated gastrointestinal symptoms (60% vs 22%, p=0.001) or history of weight loss (50% vs 16%, p=0.001) had increased odds of having an abnormal finding on CT scan compared with the patients who lacked such symptoms. Pancreatic cancer was the most commonly diagnosed malignancy. On subgroup analysis of patients with extrinsic compression and malignant lesion on imaging study, the likelihood of a malignancy was higher in blacks as compared with Hispanics (71%:29% vs 39%:61%, p=0.031), and with presence of gastrointestinal symptoms (64% vs 22%, p=0.003), presence of weight loss (64% vs 16%, p=0.0001) and hypoalbuminaemia (p=0.001).ConclusionFinding an extrinsic compression of the oesophagus and stomach on an upper endoscopy may suggest malignancy, and hence should prompt further work-up. Posterior wall gastric body compression may signal the presence of pancreatic cancer.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

Kinetics of Regulatory T-Cells Are Highly Influenced by Treatment In Patients with Gastric MALT Lymphoma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2003-2003
Author(s):  
Mar Garcia ◽  
Beatriz Bellosillo ◽  
Blanca Sanchez-González ◽  
Agustin Seoane ◽  
Luz Martínez-Avilés ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Malt Lymphoma ◽  
Critical Role ◽  
Treg Cells ◽  
Gastric Malt Lymphoma ◽  
Fold Reduction ◽  
Infiltrating Cells ◽  
The Mean ◽  
Hodgkin's Lymphomas

Abstract Abstract 2003 Background: Tumor microenvironment has been shown to play a critical role in the biology and treatment response of some types of non Hodgkin's lymphomas. The significance of the presence of Treg cells (FOXP3+) in MALT lymphomas of the stomach remains unknown. The main aim of this study was to analyze by immunohistochemistry the presence of Treg cells in the microenviroment of gastric MALT (gMALT) lymphomas at the time of diagnosis and during follow-up after treatment, and to evaluate their possible impact in outcome. Methods: Patients were included in the study if they had gMALT lymphoma diagnosed according to the 2008 WHO criteria and diagnostic paraffin-embedded blocks were available for review. Thirty-three patients met the criteria for inclusion in the study. Sections were immunostained for CD20, CD3, CD4, CD8, CD68, FOXP3, PD-1, bcl-10 and Ki67. t(11;18) was studied by FISH and/or PCR and t(1;14) by FISH. Clonality study of the B cell receptor was done according to the BIOMED-2 protocol. The number of CD20+ tumor cells and FOXP3+ infiltrating cells was quantified using a micrometric ocular (WPK 10 × mn) that has a 10 mm linear scale divided to 100 parts. Results: The median age was 63 y (range 32–83) with 52% being male. Stage: I in 66%, II in 25% and IV in 9%; B-symptoms in 6%. Translocation t(11;18) was present in 9 (27%) pts and 2 additional cases had strong nuclear expression of BCL-10 without t(11;18) or t(1;14). At diagnosis, the mean (± standard deviation) number of CD20+ tumor cells and FOXP3+ infiltrating cells was 680±232 cells/cm2 and 30±29 cells/cm2, respectively. The mean number of CD20+ tumor cells and FOXP3+ infiltrating cells was similar between gMALT with or without t(11;18). Number of treatments analyzed was 37 (treatment not available in 2 pts and 5 pts received more than 1 treatment). Treatment regimens included: eradication therapy (n=11); interferon+ribavirin (n=1); single or combined agent chemotherapy without rituximab (n=5); rituximab alone or CHOP-like with rituximab (n=4); fludarabine (n=8); fludarabine or bendamustine with rituximab (n=8). The first response evaluation showed an overall clinical response rate of 84% (CR 76%) with persistence of residual disease by histology or molecular (IGHV) studies in 31% and 56%, respectively. Overall, the mean (±SD) CD20+ tumor cells and FOXP3+ infiltrating cells was significantly reduced after treatment (730±208 vs 285±343, p<0.0001; 34±41 vs 21±36, p=0.016, respectively). The mean number of CD20+ tumor cells and FOXP3+ infiltrating cells decreased in responders (722 vs 210, p<0.001 and 37 vs 24, p=0.063, respectively) but not in non responders (p=0.279 and p=0.249). Treatment with fludarabine or bendamustine with or without rituximab induced a quick and profound depletion in the number of CD20+ cells in comparison with the other treatments (8-fold vs 2-fold reduction), but FOXP3+cell remained relatively unchanged (1.2-fold vs 2-fold reduction). The monitoring of CD20+ and FOXP3+ during follow-up and its value are under analysis (follow-up: median 4 years (range 1–8)). Conclusion: Based on these preliminary findings, there is a significant change of CD20+ cells and moderate reduction of Treg cells in responding patients after treatment for gastric MALT lymphoma. Interestingly, regimens with fludarabine or bendamustine with or without rituximab result in quicker and deeper reduction of CD20+ tumor cells while infiltrating FOXP3+ cells are only moderately reduced. Disclosures: No relevant conflicts of interest to declare.

Clinical Relevance Of Cachexia Assessed By An Anthropometric Tool In Elderly Patients With Diffuse Large B-Cell Lymphoma Treated By Immunochemotherapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2926-2926
Author(s):  
Helene Lanic ◽  
Jerome Kraut ◽  
Romain Modzelewski ◽  
Florian Clatot ◽  
Jean-Michel Picquenot ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Weight Loss ◽  
Elderly Patients ◽  
Ct Scan ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background Cancer Cachexia is a metabolic syndrome that can be present even in absence of weight loss and associated with significantly impaired survival. Muscle wasting represents a key-symptom of this syndrome and we recently demonstrated the strong prognosis impact of sarcopenia assessed by computed tomography (CT)-scan in diffuse large B-cell lymphoma (DLBCL) (Lanic et al. Leukemia & Lymphoma 2013). Conversely, the clinical relevance of loss of fat mass (adipopenia) remains unclear. The aim of this study was (i) to investigate the prognostic impact of a multidimensional tool combining a nutritional parameter (albuminemia) and body composition measurements (skeletal muscle and body fat composition) in elderly patients with DLBCL treated by chemotherapy and rituximab (R) (ii) to document the evolution of sarcopenia after immunochemotherapy. Methods This retrospective analysis included 80 DLBCL patients older than 70 years (y) and treated by R-CHOP or R-miniCHOP. Skeletal muscle (SM), visceral (V) and subcutaneal (S) adipose (A) tissues were measured by analysis of stored CT images at the Lumbar vertebrae 3 (L3) level. The surface of the muscular and adipose tissues was selected according to CT Hounsfield unit. Values were normalized for stature to calculate the L3 SM index (LSMI, in cm2/m2), the LVAI and the LSAI and used to define sarcopenia and visceral/subcutaneal adipopenia. Results The characteristics of the patients were as follows: median age = 78 y [70-95]; 36 males; IPI 0-2 = 22, 3-5 = 58; treatment by R-CHOP (n = 45) or R-miniCHOP (n = 35); median body mass index (BMI; in kg/m2) = 23.9. According to the sex-specific defined cut-offs for LSMI (< 55.8 cm²/m² for men and 38.9 cm²/m² for women), 44 DLBCL patients (55 %, 23 males) were considered as sarcopenic. With a median follow-up of 39 months, the 2y overall survival (OS) in the sarcopenic population was 46% as compared to 84% in the non-sarcopenic group (HR = 3.12; CI95%, 1.66-5.88; p=0.0004). The median LSAI was 76.3 cm2/m2 [10-167] in females and 47.4 cm2/m2[22-100] in males. The median LVSAI was 43.5 cm2/m2[3-141] in females and 50.4 cm2/m2[14-159] in males. Adipopenia, defined by a low LVAI and/or a low LSAI was also highly predictive of the outcome. The 2y OS of the low LVAI population was 48% as compared to 82% for the non-adipopenic group (HR = 2.20; CI95%, 1.19-4.05; p=0.01). The 2y OS in the low LSAI population was 48% as compared to 80% in the non-adipopenic group (HR = 2.28; CI95%, 1.23-4.21; p=0.008). A Three-point cachexia score (CS) including adipopenia, sarcopenia and hypo-albuminemia (defined by an albuminemia < 35 g/L) was build and delineates three distinct risk-groups (Figure 1). More importantly the CS remains predictive of the prognosis in a multivariate analysis including BMI (< or >= 25 kg/m2), age (< or >= 80y), IPI and gender (HR=2.5; CI95%= 1.14-5.39; p =0.02). LMSI was subsequently reassessed in thirty seven patients during the routine CT scan follow-up [mean = 10 months after pre-treatment CT scan (range 2.8-19.2)]. 15 (40%) patients displayed a 5% decrease of their LSMI, whereas 13 (35%) and 9 (25%) displayed no significant change or increase (>5%) of the LMSI respectively. Conclusion Our study demonstrates that sarcopenia and adipopenia estimated by CT-scan define cachexia more accurately than BMI or weight loss in elderly DLBCL patients. These factors can be integrated in a cachexia scoring tool which predicts the outcome independently of the BMI and of the IPI. CT scan follow-up indicates that cachexia is a reversible process that should be integrated as part of the therapeutic target in combination with lymphoma treatment. A prospective multicentric trial (registered as NCT01715961/Clinical.gov) is ongoing to validate these anthropometric and nutritional parameters and compare to geriatric assessment scales. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Juxtapapillary duodenal diverticulitis in an elderly female

2019 ◽  
Vol 12 (4) ◽  
pp. e229259
Author(s):  
Andrew Groff ◽  
Leonard Walsh ◽  
Manpreet Singh ◽  
Rohit Jain
Keyword(s):  
Abdominal Pain ◽  
Clinical Presentation ◽  
Duodenal Diverticulum ◽  
Purulent Discharge ◽  
Caucasian Woman ◽  
Upper Endoscopy ◽  
Imaging Findings ◽  
Elderly Female ◽  
Duodenal Diverticulitis

We describe the case of an 82-year-old Caucasian woman who presented to our institution as a transfer from an outside hospital with nausea, vomiting and abdominal pain with CT imaging concerning for a duodenal mass or abscess in the juxtapapillary region of the second part of the duodenum. Upper endoscopy showed a non-bleeding duodenal diverticulum with purulent discharge consistent with diverticulitis. She underwent endoscopic disimpaction with irrigation and received a 14 day course of antibiotics, after which she presented for follow-up 1 month after discharge without complications. This case highlights the rarity of juxtapapillary duodenal diverticulitis, its nonspecific clinical presentation and imaging findings and the importance of early diagnosis and management to prevent severe complications including perforation.

scholarly journals Disseminated Gastric MALT Lymphoma with Monoclonal Gammopathy, t(11;18)(q21;q21), and Subsequent Development of T-Large Granular Lymphocytic Leukemia: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Riad Akoum ◽  
Wassim Serhal ◽  
Hussein Farhat
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Malt Lymphoma ◽  
Peripheral Blood ◽  
Marginal Zone ◽  
Granular Cell ◽  
Gastric Malt Lymphoma ◽  
Review Of The Literature ◽  
Malt Type Lymphoma ◽  
Hodgkin's Lymphomas

Background. Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is a well-characterized entity that may share clinical and morphological findings with other low-grade non-Hodgkin’s lymphomas. Dissemination of MALT-type lymphoma to bone marrow and peripheral blood simultaneously with the presence of T-large granular cell leukemia (T-LGL) has rarely been reported.Case Presentation. This is the case of a 42-year-old male who presented with a gastric MALT-type lymphoma, disseminated to the bone marrow and the peripheral blood with high serum IgM levels and t(11;18)(q21;q21). The morphological, immunophenotypical and, immunohistochemical studies of the successive bone marrow and peripheral blood samples had revealed the coexistence of two distinct lymphoma cell populations: a B-cell, marginal zone type population expressing CD19, CD20, CD22, CD79b, IgM, and kappa light chain, and a T-large granular cell population, developed after treatment with rituximab expressing CD3, CD8, CD5, CD7, and CD45.Conclusion. Based on the analysis of this unusual case we performed an extensive review of the literature to elucidate the relationship between T-LGL and B-cell lymphomas and to emphasize the importance of paraprotein analysis at diagnosis of gastric MALT lymphoma.

Exclusive moderate-dose radiotherapy in gastric marginal zone B-cell MALT lymphoma: Results of a prospective study with a long term follow-up

2015 ◽  
Vol 117 (1) ◽  
pp. 178-182 ◽  
Author(s):  
Agnès Ruskoné-Fourmestraux ◽  
Tamara Matysiak-Budnik ◽  
Bettina Fabiani ◽  
Pascale Cervera ◽  
Hedia Brixi ◽  
...  
Keyword(s):  
Prospective Study ◽  
B Cell ◽  
Malt Lymphoma ◽  
Marginal Zone ◽  
Moderate Dose ◽  
Long Term Follow Up ◽  
A Prospective Study

scholarly journals A case of primary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphoma treated by radiofrequency ablation (RFA), and a literature review

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199953
Author(s):  
Zhe Xu ◽  
Chong Pang ◽  
Jidong Sui ◽  
Zhenming Gao
Keyword(s):  
Radiofrequency Ablation ◽  
B Cell ◽  
Malt Lymphoma ◽  
Lymphoid Tissue ◽  
Marginal Zone ◽  
B Cell Lymphoma ◽  
Liver Malignancy ◽  
Characteristic Imaging ◽  
Malt Type Lymphoma

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare liver malignancy that usually lacks characteristic imaging findings and which is often misdiagnosed. We report a 63-year-old woman diagnosed with primary hepatic extranodal marginal zone B-cell lymphoma, MALT type. The patient underwent needle biopsy and radiofrequency ablation (RFA), and showed no signs of relapse during the 12-month postoperative follow-up. This case stresses the rarity of primary hepatic MALT-type lymphoma and the unique and effective treatment for this patient. Our patient received RFA, which showed good efficacy and which provides a new option for the treatment of hepatic MALT lymphoma. We also present our findings from a systematic review to improve the current understanding of this disease.

scholarly journals Endolimax nana and urticaria

2020 ◽  
Vol 14 (03) ◽  
pp. 321-322 ◽  
Author(s):  
Stefano Veraldi ◽  
Luisa Angileri ◽  
Luisa Carlotta Rossi ◽  
Gianluca Nazzaro
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Chronic Urticaria ◽  
Blood Eosinophilia ◽  
Italian Woman ◽  
Laboratory Examinations

Endolimax nana is a commensal protozoan of the colon. We report a case of chronic urticaria associated with E. nana in a 34-year-old Italian woman. The patient suffered from abdominal pain, diarrhoea and weight loss. The disease appeared after a trip to Vietnam. Laboratory examinations showed mild blood eosinophilia. Three coproparasitological examinations were positive for cysts of E. nana. The patient was successfully treated with two courses of metronidazole (2 g/day for 10 days each). No antihistamines were used. Three coproparasitological examinations, carried out at the end of the therapy, were negative. Follow up (six months) was negative. E. nana can be responsible for very rare cases of abdominal pain, diarrhoea, polyarthritis and urticaria.

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