Collagenous enteritis as a rare cause of exudative enteropathy in a child. Case report

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Abstract

Exudative enteropathy (EE) syndrome can be associated with various diseases of the gastrointestinal tract (GIT) and is manifested by edematous syndrome, hypoproteinemia, hypoalbuminemia, lymphocytopenia, hypogammaglobulinemia, and an increase in the level of α-1-antitrypsin in the feces. More than 60 medical conditions are associated with loss of protein through the gastrointestinal tract, including erosive-ulcerative diseases of the gastrointestinal tract, non-erosive lesions of the mucous membrane causing an increase in the permeability of the intestinal wall, as well as disorders with an increase in pressure in the lymphatic system. Correct diagnosis and timely replacement and pathogenetic therapy are essential for the rapid cessation of pathological losses, the recovery of the proteinogram, and the prevention of life-threatening complications. Collagenous enteritis is one of the rare diseases of the small intestine associated with EE syndrome. The article presents a clinical case of a young child with EE and collagenous enteritis. The stages of the diagnostic workup in detecting EE syndrome in the child are discussed, and the pathogenetic factors that determined the development of this disorder are considered.

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About the authors

Yulia A. Dmitrieva

Russian Medical Academy of Continuous Professional Education; Bashlyaeva Children’s City Clinical Hospital

Author for correspondence.
Email: jadmitrieva@mail.ru
ORCID iD: 0000-0003-0668-7336

Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Irina N. Zakharova

Russian Medical Academy of Continuous Professional Education

Email: zakharova-rmapo@yandex.ru
ORCID iD: 0000-0003-4200-4598

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Andrey L. Zaplatnikov

Russian Medical Academy of Continuous Professional Education

Email: zaplatnikov@mail.ru
ORCID iD: 0000-0003-1303-8318

D. Sci. (Med.); Prof.

Russian Federation, Moscow

Elena R. Radchenko

Bashlyaeva Children’s City Clinical Hospital

Email: elen.radchenko@list.ru
ORCID iD: 0000-0001-5717-7171

Gastroenterologist

Russian Federation, Moscow

Elena I. Epifanova

Bashlyaeva Children’s City Clinical Hospital

Email: jadmitrieva@mail.ru
ORCID iD: 0000-0003-3795-3203

Pathologist

Russian Federation, Moscow

Lala S. Abdurakhmanova

Children’s Medical Center, Moscow

Email: lalina92@inbox.ru
ORCID iD: 0000-0001-6457-1193

Gastroenterologist

Russian Federation, Moscow

Polina Y. Pokhvashcheva

Pirogov Russian National Research Medical University

Email: pokhvashcheva98@mail.ru
ORCID iD: 0000-0001-9983-6032

Resident

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Diagnostic algorithm for the detection of hypoproteinemia and hypoalbuminemia syndrome [1].

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3. Fig. 2. Swelling of the soft tissues of the face and scrotum in the patient (authors’ observation).

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4. Fig. 3. Change over time of the patient’s proteinogram during therapy.

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5. Fig. 4. Histological pattern of collagenous enteritis: fragments of the mucous membrane of the duodenum with shortened and dilated villi, hyperplasia of crypts; subepithelial focal deposition of homogeneous slightly eosinophilic collagen-positive masses with Masson staining with aniline blue.

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