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Diffuse nodular lymphoid hyperplasia of the small bowel associated with common variable immunodeficiency and giardiasis: a rare case report

Diffuse noduläre lymphoide Hyperplasie des Dünndarms mit gewöhnlicher variabler Immundefizienz und Giardiasis: Fallbericht einer seltenen Erkrankung

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Summary

Diffuse nodular lymphoid hyperplasia (DNLH) of the intestine is an extremely rare lymphoproliferative disorder of uncertain etiology. Typically, numerous polypoid nodules composed of hyperplastic benign lymphoid tissue are present in the small and/or large intestinal mucosa. DNLH has been observed in association with common variable immunodeficiency (CVID). A 38-years-old man was admitted to our clinic due to dyspeptic complaints. An upper gastrointestinal system endoscopic examination revealed DNLH in the duodenum. A biopsy specimen showed the presence of nodular lymphoid hyperplasia and a Giardia lamblia infection in the duodenum. CVID was suspected, and the diagnosis was established by demonstrating a significant reduction in the serum gamma-globulin levels. DNLH is a rare benign condition with regards to diagnosis and treatment of unknown etiology. In patients with DNLH, screening for the immune deficiencies is being important in addition to histopathological examinations.

Zusammenfassung

Die diffuse noduläre lymphoide Hyperplasie (DNLH) des Darms ist eine extrem seltene lymphoproliferative Erkrankung ungesicherter Ätiologie. Typisch für die Erkrankung sind zahlreiche polypoide Knoten in der Mukosa des Dünn- und/oder Dickdarms, die aus benignem hyperplastischem lymphoiden Gewebe bestehen. Es liegen Berichte über ein mit gewöhnlicher passagerer Immundefizienz (CVID) gemeinsames Auftreten vor.

Ein 38-jähriger Patient wurde auf unserer Klinik wegen dyspeptischer Beschwerden aufgenommen. Eine Gastro-Duodenoskopie ergab das Vorliegen einer DNLH im Duodenum. Im bioptischen Material wurde eine noduläre lymphoide Hyperplasie, sowie eine Infektion mit Giardia lamblia festgestellt. Eine suspizierte CVID wurde durch den Nachweis einer signifikant verminderten Gammaglobulinämie bestätigt.

Was die Diagnose und Therapie betrifft, ist die DNLH eine seltene benigne Erkrankung – allerdings unklarer Ätiologie. Bei Patienten mit DNLH sollte zusätzlich zur Histologie ein Screening auf Immundefizienz durchgeführt werden.

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Authors and Affiliations

  1. Department of Gastroenterology, Medical Faculty,Yuzuncu Yil Universitesi, 65000, Van, Turkey

    Sehmus Olmez & Ahmet Cumhur Dulger

  2. Department of Internal Medicine, Medical Faculty,Yuzuncu Yil Universitesi, Van, Turkey

    Mehmet Aslan

  3. Department of Radiology, Medical Faculty,Yuzuncu Yil Universitesi, Van, Turkey

    Alpaslan Yavuz

  4. Department of Pathology, Medical Faculty,Yuzuncu Yil Universitesi, Van, Turkey

    Gulay Bulut

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  1. Sehmus Olmez
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  2. Mehmet Aslan
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  3. Alpaslan Yavuz
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  4. Gulay Bulut
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  5. Ahmet Cumhur Dulger
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Correspondence to Sehmus Olmez.

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Olmez, S., Aslan, M., Yavuz, A. et al. Diffuse nodular lymphoid hyperplasia of the small bowel associated with common variable immunodeficiency and giardiasis: a rare case report. Wien Klin Wochenschr 126, 294–297 (2014). https://doi.org/10.1007/s00508-014-0525-5

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