Residency Program - Case of the Month

Clinical history:

The patient is a 55 year old male with a past medical history significant for hypertension and osteoarthritis who presented with a 3 to 4 month history of alternating diarrhea with steatorrhea and constipation. He also noted fevers and an unintentional 40 lbs weight loss.

Abdominal CT demonstrated multiple enlarged mesenteric lymph nodes with no other abnormalities. Liver function tests and serum amylase and lipase were within normal limits. Stool culture grew normal fecal flora, and the ova and parasites exam was negative. Multiple small polyps (< 5 mm) were found on colonoscopy, but the colonic mucosa otherwise appeared unremarkable. Esophagogastroduodenoscopy (EGD) showed nonerosive gastropathy in the antrum and what was described as “frosted” duodenal mucosa. Biopsies of the colonic polyps, colon, and frosted area of the duodenum were taken.

Microscopic Photographs:

Fite Stain	PAS with Diastase

ANSWER