Cap polyposis with protein-losing enteropathy.

A 56-year-old male with a history of mild mental retardation, noninsulin-dependent diabetes mellitus, and hypertension presented with diarrhea and lower extremity edema of several months’ duration. The patient’s symptoms started with mild, intermittent diarrhea; several months later, his diarrhea became persistent, and he was admitted to a hospital. The patient was given metronidazole (Flagyl, Pfizer); when he did not respond to this treatment, a sigmoidoscopy was performed, revealing large inflammatory polyps with marked congestion and granulation tissue. Due to worsening symptoms, the patient underwent a left hemicolectomy, during which multiple inflammatory polyps were noted. The intervening colonic mucosa showed mild crypt distortion, which was suggestive of inflammatory bowel disease. The patient’s symptoms subsided immediately after surgery; however, 8 months later, his diarrhea recurred and began to increase in frequency. At this time, the patient’s diarrhea was explosive and consisted of a large volume of liquid. A subsequent colonoscopy revealed polyps similar to those seen during the patient’s previous colonoscopy, and the intervening mucosa showed mild crypt distortion with foci of cryptitis, which was suggestive of inactive ulcerative colitis. One year after his initial presentation, the patient was transferred to our institution with a 30-lb weight loss from baseline, up to 24 bowel movements per day, blood in his stool, and severe lower extremity edema. On laboratory examination, the patient had a hemoglobin level of 10.5 g/dL (normal, 13.5–17.5 g/dL), mean corMarlene Gallegos, MD1 Cynthia Lau, MD2 Dawn P. Bradly, MD1 Luis Blanco, MD1 Ali Keshavarzian, MD2 Shriram M. Jakate, MD1 1Department of Pathology 2Department of Gastroenterology Rush University Medical Center Chicago, Illinois