Anaemia in Waldmann’s disease: A rare presentation of a rare disease

Abstract

A 32-year-old female presented with 5-year history of iron deficiency anemia, marked pallor and edema of both lower limbs. Laboratory investigations including complete blood count, blood film, iron studies, lipid profile, ascitic fluid analysis, test of stool for occult blood and alpha 1 anti-trypsin. Upper, lower gastrointestinal (GIT) endoscopies, and enteroscopy were performed. Imaging techniques as abdominal ultrasonography and computed tomography were done. Echocardiography, lymph node biopsy and bone marrow examination were normal. The case was diagnosed as Waldmann’s disease with protein losing enteropathy and recurrent GIT bleeding. Management started with low fat diet with medium chain triglyceride, octreotide 200 μg twice a day, tranexamic acid and blood transfusion. Then, exploratory laparotomy with pathological examination of resected segment was done when recurrent GIT bleeding occurred and to excluded malignant transformation.

Keywords: Waldmann’s disease; Lymphangiectasia; Gastrointestinal bleeding; Iron deficiency anemia

Core tip: To our knowledge, this is the first “Egyptian” case of primary intestinal lymphangiectasia. In addition, its presentation is rare with blood loss anemia in contrast to the more common presentation with hypoproteinemia and edema. So, we are reporting a case with a rare clinical presentation of a rare disease. Double balloon enteroscopy was so beneficial in the diagnosis of the case superior to capsule endoscopy because the advantage of biopsy and histopathologic examination. There is controversy about medical treatment options, surgical treatment may be preferred in localized lesions otherwise, has no role. Prognosis may be favorable.