A 73-year-old woman with weight loss of 10 kg, asthenia and anorexia, as well as watery diarrhea lasting 4 months.
She had epigastric pain and arthralgia in her wrists, shoulders and ankles for 15 days.
The examination revealed hyperpigmentation, malnutrition and signs of arthritis in the left wrist.
Laboratory tests showed microcytic anemia and low albumin levels.
The gastrointestinal transit showed intestinal loops and flocculation of contrast.
No lymphadenopathy was observed on CT.
Oral endoscopy revealed multiple diffuse whitish formations consistent with lymphangiectasia.
Histopathology showed the classic lipodystrophy with PAS positive macrophages and characteristic bacillilar forms in e-mail.
She was treated with TM-SF for one year, but the persistent positive SBP material on biopsy continued treatment for two years.
The patients weight loss and symptoms disappeared but the biopsy did not normalize up to two years after the end of treatment.
