LIBYAN PATIENT WITH CHRONIC DIARRHEA

A 22-year-old Libyan patient suffering from chronic diarrhea presented with an alpha-heavy chain paraprotein and a lymphoplasmacellular lymp homa infiltration of the duodenal mucosa. These findings supported the diagnosis of >>immunoproliferative small intestinal disease<< (IPSID) . In this disease, that occurs almost solely in countries with low soc ioeconomic status, a diffuse infiltration of small intestinal mucosa b y neoplastic lymphoid cells causes chronic malabsorption. About 65% of patients exhibit a paraprotein in serum, urine, or jejunal juice that consists of the heavy chain of immunoglobulin A (alpha-heavy chain). In advanced stages, IPSID resembles histologically and clinically high grade lymphoma: some patients develop masses in the gut wall, an abdo minal lymphadenopathy and involvement of other organs including bone m arrow. The disease is believed to be triggered by a chronic infectious antigenic stimulus. Thus, in early stages in some patients cure may b e achieved by antibiotic therapy alone. In advanced disease, chemother apy including anthracyclins is necessary.