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An unusual cause of intestinal failure
  1. Gavin Alistair Stead1,
  2. Ben Warner1,
  3. Jennifer Clough1,
  4. Effie Lanaspre2,
  5. John O’Donohue1
  1. 1Department to Gastroenterology, University Hospital Lewisham, London, UK
  2. 2Department of Pathology, University Hospital Lewisham, London, UK
  1. Correspondence to Dr Gavin Alistair Stead, Department to Gastroenterology, University Hospital Lewisham, London SE13 6LH, UK; g.a.stead{at}doctors.org.uk

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A 62-year-old man presented to the emergency department with 5 weeks of worsening lower abdominal pain associated with watery diarrhoea, vomiting and 10% loss of body weight. He had recently experienced night blindness.

There was no history of foreign travel. His past medical history included hypertension, sickle cell trait and type 2 diabetes well controlled on metformin. He had not been prescribed any recent steroids and denied significant alcohol intake.

On examination, he had a tachycardia at 110 bpm and was afebrile and normotensive. He was malnourished with pedal pitting oedema extending to both knees. His abdomen was soft but distended and diffusely tender.

Blood tests showed a serum albumin …

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