Case of the Month: March 2005
 
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"A multisystem disorder affecting the gut"

Fortun P1, Kaye P2, Mahmoud A3
1Lecturer in Gastroenterology, Wolfson Digestive Disease Centre University Hospital Nottingham, UK / 2Consultant Histopathologist, Dept. of Histopathology, University Hospital Nottingham, UK / 3Consultant Gastroenterologist, Kings Mill Hospital, Nottinghamshire, UK

Correspondence to: paul.fortun@nottingham.ac.uk

  Case report  



A 59 year old woman presented with weight loss, anaemia, and abnormal liver function tests (Table 1).



  Table 1  



 
bilirubin 10 umol/L (ref < 18)
albumin 48 g/L (35-50)
alkaline phosphatase 550 u/L (35-130)
alanine transferase 14 (<30)
gamma glutamyl transferase 50 (7-32)
Haemoglobin 10 (11.5-16.6)
total white count 3.8 (4-11)
neutrophils 1.9 (2-7.5)
platelets 115 (140-400)
ESR 46 (1-13).
 



  The following tests were performed:  



 
  • Skeletal survey showing diffuse sclerosis
  • Raised IgM 4.8 g/l(0.5-1.9)
  • Urinary Bence Jones protein: normal
  • Ultrasound liver: normal, no organomegaly
  

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