Internal Medicine A, Liver Unit, Hebrew University-Hadassah Medical Organization, P.O. Box 12000, Jerusalem IL 91120, Israel.
Protein-losing gastroenteropathies are characterized by an excessive loss of serum proteins into the gastrointestinal tract, resulting in hypoproteinemia (detected as hypoalbuminemia), edema, and, in some cases, pleural and pericardial effusions. Protein-losing gastroenteropathies can be caused by a diverse group of disorders and should be suspected in a patient with hypoproteinemia in whom other causes, such as malnutrition, proteinuria, and impaired liver protein synthesis, have been excluded. In this paper, we present a case of protein-losing enteropathy in a 22-year-old immunocompetent male with a coinfection of CMV and Hp.
Protein-losing gastroenteropathies can be caused by a diverse group of disorders, in which an increase in intestinal leakage of plasma proteins occurs. This leakage can occur via either mucosal injury or increased lymphatic pressure in the gut. Laboratory findings include reduced serum concentrations of albumin, gamma globulins, fibrinogen, transferrin, and ceruloplasmin. The hypoalbuminemia may lead to edema of the lower extremities.
A variety of benign and malignant conditions can be associated with protein-losing gastroenteropathy, for example, IBD and gastrointestinal malignancies. However, in otherwise healthy patients, the role of CMV in the pathogenesis has been suggested. A gastric biopsy in a few reported cases demonstrated the presence of CMV. However, most of these patients were children who had a typical benign and transient course and required only supportive therapy. Around 90 cases of gastrointestinal involvement were reported in healthy adult patients, the great majority with colonic involvement, among them none had coinfection with Hp. We describe a case of erosive gastritis with significant protein-loss, admitted to our department for evaluation because of vomiting and abdominal pain. Gastric-mucosal biopsy revealed morphological evidence of both CMV and Hp infection.
**Editor's note: Many lymphedema patients also have lymphangiectasia, which is a protein-loosing entropathy. One complication is the disruption of the lymphatic processes of the intestine. This in turns contributes to over all edema, processing of fat and proteins. Because of this,. I have included this.**