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DOI: 10.1055/s-0030-1256003
© Georg Thieme Verlag KG Stuttgart · New York
A fulminant course of Cronkhite-Canada syndrome
J. MartinekMD, PhD
Department of Internal Medicine
Central Military Hospital
U Vojenská nemocnice 1200
Praha 6
Czech Republic
eMail: jan.martinek@volny.cz
Publikationsverlauf
Publikationsdatum:
17. Dezember 2010 (online)
A 57-year-old man suffered from watery diarrhea, weight loss, and abdominal pain for 4 months. Noticeable signs of nail dystrophy (onychomadesis of all nails) were present ([Fig. 1 a]) along with alopecia and cutaneous foci of hyperpigmentation ([Fig. 1 b]).
Upper-gastrointestinal endoscopy revealed a large number of strawberry-like polyps of different size in the stomach ([Fig. 2]).
Colonoscopy revealed polyposis of the whole colon, including the rectum. The majority of the polyps had a strawberry-like, adenomatous, and hyperplastic appearance ([Fig. 3]).
Histologically, the majority of the polyps were juvenile-like with cystic dilatations of the glands and a benign mucinous epithelium. The glands were filled with a large amount of mucin ([Fig. 4]).
Qualität:
Qualität:
Some adenomatous polyps with low-grade dysplasia in the colon were also detected. A subsequent enteroscopy did not find polyps; however, edema and small indentation of the jejunum were present. Immunohistochemistry showed total alactasia and a strong positivity for tumor necrosis factor (TNF) in the macrophages and lymphocytes. Based on both the clinical and endoscopic picture, a diagnosis of Cronkhite-Canada syndrome was established.
Despite complex treatment, the clinical course was unfavourable. Since the clinical state of the patient did not improve, anti-TNF-α treatment was considered. TNF-α activity was examined in the small-intestinal mucosa, and the results showed a strong intracellular expression of TNF-α. Unfortunately, an experimental anti-TNF-α treatment could not be introduced, because of the rapid progression of the disease. The patient died 4 months after the diagnosis of Cronkhite-Canada syndrome was established.
Cronkhite-Canada syndrome is a rare non-hereditary polyposis syndrome of an unknown, possibly autoimmune etiology. The prognosis is poor and more than 50 % of patients die within 2 – 4 years [1] [2]. Cronkhite-Canada syndrome should be considered in all patients with gastrointestinal polyposis together with emergent alopecia and/or nail dystrophy [3].
Competing interests: None
Endoscopy_UCTN_Code_CCL_1AD_2AC
#References
- 1 Tao K, Patel J K, Pampati V. Cronkhite-Canada syndrome: a case report and review of the literature. Gastroenterol Res Pract. 2009; Article ID 619378
- 2 Goto A. Cronkhite-Canada syndrome: epidemiological study of 110 cases reported in Japan. Nippon Geka Hokan. 1995; 64 3-14
- 3 Kojima E, Tomita A, Matsumura M, Kinoshita I. Magnifying the endoscopic appearance of Cronkhite–Canada syndrome. Gastrointest Endosc. 2009; 70 1242-1243
J. MartinekMD, PhD
Department of Internal Medicine
Central Military Hospital
U Vojenská nemocnice 1200
Praha 6
Czech Republic
eMail: jan.martinek@volny.cz
References
- 1 Tao K, Patel J K, Pampati V. Cronkhite-Canada syndrome: a case report and review of the literature. Gastroenterol Res Pract. 2009; Article ID 619378
- 2 Goto A. Cronkhite-Canada syndrome: epidemiological study of 110 cases reported in Japan. Nippon Geka Hokan. 1995; 64 3-14
- 3 Kojima E, Tomita A, Matsumura M, Kinoshita I. Magnifying the endoscopic appearance of Cronkhite–Canada syndrome. Gastrointest Endosc. 2009; 70 1242-1243
J. MartinekMD, PhD
Department of Internal Medicine
Central Military Hospital
U Vojenská nemocnice 1200
Praha 6
Czech Republic
eMail: jan.martinek@volny.cz