Polyposis of the
gastrointestinal tract as a manifestation of diffuse follicular
lymphatic hyperplasia.
Dtsch Med
Wochenschr. 1998 Mar 20;123(12):347-52.
HISTORY AND
ADMISSION FINDINGS: A 21-year-old previously healthy Turkish man who
had been living in Germany for 15 years was admitted because of
worsening cramp-like abdominal pain with nausea, vomiting and watery
diarrhoea. Palpation elicited diffuse muscular guarding over the
entire abdomen and a mass of about 8 cm in the right lower abdomen.
INVESTIGATIONS: Abnormal laboratory results were erythrocyte
sedimentation rate (55 mm), C-reactive protein (6.2 mg/dl), total
bilirubin (2.1 mg/dl), creatine kinase (137 U/l) and thymidine kinase
(5.5 U/l). There was a slight leucocytosis (13,700/microliter) and
mild anaemia (haemoglobin 13.4 g/dl) with a normal differential count.
Listeria ivanovii was repeatedly cultured from stool. Ultrasonography
and computed tomography of the abdomen demonstrated a 6 cm mass in the
right lower abdomen, splenomegaly (15.5 x 5 cm) and several lymphomas,
up to 1.8 cm in diameter. Endoscopy revealed dense, in part
grass-like, polyps, 3 to 6 mm deep, in the mucosa from the terminal
ileum to the rectum, and to a lesser extent also in the duodenum.
Histological examination of the polyps demonstrated diffuse follicular
hyperplasia without evidence of malignancy. TREATMENT AND COURSE: On
antibiotic treatment with ofloxacin (2 x 400 mg intravenously) the
symptoms quickly regressed, but the endoscopic findings remained
unchanged. CONCLUSION: Diffuse follicular lymphatic hyperplasia
manifested itself in this patient as diffuse gastrointestinal
polyposis. Listeria ivanovii cannot be ruled out as a causative
factor. |
