Protein-losing enteropathy due to gastro-intestinal amyloidosis.

Case report A 57-year-old male presented with a 10-day history of oedema rising to the level of the xiphisternum. Examination also revealed coarse crepitations over the left upper lung field and finger clubbing. Ten years earlier he had been treated with standard chemotherapy for pulmonary tuberculosis and subsequently developed severe bronchiectasis with persistently purulent sputum. Investigations showed a serum total protein of 54 g/l; albumin 13 g/l; with a normal electrophoretic pattern. The ESR was persistently elevated to 120 mm (Westergren) in the first hour. Haemoglobin 11-6 g/dl, MCV 99 fl; MCHC 31-2 g/dl; with a normal white cell count. Plasma urea and electrolytes were normal. Chest X-ray showed widespread cystic changes in the left lung with fibrosis affecting the right upper lobe. Urine and sputum cultures were negative for acid and alcohol-fast bacilli. He had a normal dietary protein intake of 110 g/day. There was no evidence of malabsorption as the serum calcium, phosphate, alkaline phosphatase, folic acid and vitamin B12 levels, glucose tolerance test, 5-day faecal fat excretion and D-xylose absorption were all normal. Gastroscopy and barium meal with follow-through were normal as were his liver function tests, liver scan and hepatic angiogram.