A 67-year-old man with
nausea, appetite loss, frequent
diarrhea and severe
weight loss presented with
alopecia, skin
hyperpigmentation and onychodystrophy. Laboratory investigations showed mild
anemia,
hypoproteinemia and
hypoalbuminemia. Colonoscopy identified the numerous, hyperemic and sessile
polyps with mucous exudation of various sizes throughout the colorectum. The ileocecal valve was substantially swollen. Magnified chromoendoscopy revealed sparsely distributed crypt openings with widening of the preicryptal space without destruction in the affected lesions. Upper gastrointestinal endoscopy revealed multiple small, reddish, and sessile
polyps in the duodenum and Helicobacter pylori-associated
gastritis. Histopathological examination of the
colonic polyps revealed cystic dilatation and elongation of scattered glands with epithelial
hyperplasia and stromal
edema and inflammatory cell infiltrates. Thus, a diagnosis of
Cronkhite-Canada syndrome was made. The patient was given
clarithromycin,
amoxicillin and
lansoprazole, resulting in negative (13)C-urea breath tests. Three months later, his clinical symptoms and
edema of the legs resolved with normalization of serum total
protein and
albumin levels and return to his previous body. The ectodermal abnormalities were resolved 8 months later. On repeat colonoscopic examinations, there was progressive remission of the duodenal and colorectal polyposis, leaving scattered pedunculated
polyps in the transverse and ascending colon and on the almost normal-appearing ileocecal valve. At the follow-up magnifying endoscopic examination 8 months later, small round or round-oval pits were densely and regularly distributed.