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Chylous reflux into abdominal skin simulating lymphangioma circumscriptum in a patient with primary intestinal lymphangiectasia.

A 47-year-old man with primary intestinal lymphangiectasia developed chylous reflux into the skin of the right flank. The clinical appearance resembled lymphangioma circumscriptum with multiple dome-shaped vesicles filled with milky-white fluid which discharged on to surrounding skin. Backflow of chyle into the skin of the lower limb, perineum or external genitalia has been described as a rare finding in patients with primary lymphoedema but we believe this to be the first case involving the abdomen and the first case describing chylous reflux into the skin in a patient with intestinal lymphangiectasia.

Blister↗

Vulvar lymphangiectasia due to recurrent cellulitis.

We describe a 42-year-old woman in whom extensive lymphangiectasia of the vulva developed after recurrent severe episodes of cellulitis, producing changes rather similar to those seen in lymphangioma circumscriptum. We suspect that an underlying lymphatic abnormality predisposed her to cellulitis, resulting in local lymphatic fibrosis and vulvar lymphangiectasia.

Adult↗

Familial pachydermoperiostosis in association with protein-losing enteropathy.

In this report we describe a rare association of pachydermoperiostosis with protein-losing enteropathy (PLE) in a family of three brothers. The first brother had the complete form of pachydermoperiostosis along with PLE. The second brother had the 'forme fruste' of pachydermoperiostosis, with minimal skin changes, bony abnormalities and PLE, which was due to intestinal lymphangiectasia. The third brother had an incomplete form of pachydermoperiostosis without evidence of PLE. To our knowledge, the association of pachydermoperiostosis with PLE due to intestinal lymphangiectasia has not been reported previously.

Adolescent↗

Rapidly fatal lymphangioma-like Kaposi's sarcoma.

A 34-year-old black South African male was treated for lymphangioma-like clinical Kaposi's sarcoma. The disease followed a rapidly fatal course and was characterized by unexplained recurrent pleural effusions and severe refractory anaemia due to the presence of dilated vascular channels in the bone marrow. Definitive diagnosis was only made at autopsy. Lymphangiomatous changes in the skin without spindle cell formation caused diagnostic difficulties.

Adult↗

Lymph-vessel embolism in a case of Whipple's disease.

A case of Whipple's disease is described where the lymphatics in the regional lymph nodes appear to be obstructed by embolized macrophages, containing the characteristic PAS positive bacillary material. It is suggested that the regional lymphangiectasia in Whipple's disease may in part result from such cellular embolism.

Biopsy↗

Enamel hypoplasia of the primary dentition in a 4-year-old with intestinal lymphangiectasia.

Intestinal lymphangiectasia (IL) is a rare disorder, and its incidence and prevalence is unknown for either Australia or world-wide. It is characterized by diarrhoea, mild steatorrhoea, oedema, enteric loss of protein (protein-losing enteropathy) and abnormal dilated lymphatic channels in the small intestine. Whilst oedema and diarrhoea are the predominant clinical features, other observed features include hypoalbuminemia, hypogammaglobulinemia, trace metal deficiency, hypocalcemia and chylous pleural effusions. While medical presentation of the condition has been reported widely, few descriptions of oral findings have been published. A search of Medline found two reports of dental findings in the permanent dentition in patients with IL. To date, there have been no reports on dental findings in the primary dentition. The primary dentition of a 4-year-old boy with IL had teeth with enamel defects which reflected the timing of enamel development and the period in which the disease was active. The present report highlights the need for early involvement of the dental team in the dental management of children with IL.

Child, Preschool↗

Low energy fluence CO2 laser treatment of lymphangiectasia.

Lymphangiectasia is an uncommonly reported complication of lymphatic insufficiency. These dilatations of lymphatic vessels may be symptomatic, necessitating treatment. While CO2 laser ablation has been used with success in the treatment of lymphangiectasia, it is infrequently reported and previous laser protocols have relied on high irradiances. The successful use of low fluence CO2 laser in the treatment of multiple lymphangiectases on the lower limb of a middle-aged Caucasian woman with unilateral chronic lymphoedema is described.

Female↗

Intestinal lymphangiectasia--a report in two Chinese children.

Two Chinese infants with asymmetrical lymphoedema and steatorrhoea were investigated. The laboratory investigations showed that they had hypoproteinaemia without proteinuria. One of them showed peripheral lymphopenia and hypogammaglobulinaemia. Radiologically, they had evidence of extensive lymphangiectasia of the small intestine. This was confirmed histologically. Endoscopy of one of them showed diffuse milky nodular duodenal mucosa. The appearance of the mucosa was rather typical of intestinal lymphangiectasia.

Endoscopy↗

Protein-losing enteropathy due to intestinal lymphangiectasia accompanied by mesenteric lymph node fibrosis.

An autopsy case of a 74-year-old man suffering from edema in the legs and diagnosed as protein-losing enteropathy due to intestinal lymphangiectasia is presented. He underwent a radical operation and radiotherapy for esophageal carcinoma at age 65 years and the onset of protein-losing enteropathy was at age 70. Postmortem examination disclosed widespread abnormalities of the duodenal and small intestinal lymphatics and mesenteric lymph node fibrosis. The mucosal lymphatic capillaries were markedly dilated. In the submucosal and serosal layers, the lymphatic vessels showed marked dilatation in some areas and fibrous occlusion with very thick muscle layers in others. All these lymphatic changes were presumed to be attributable to a reactive process secondary to lymph congestion, which it is suggested, was caused by the mesenteric lymph node fibrosis.

Aged↗

Intestinal lymphangiectasia with protein losing enteropathy, toxic copper accumulation and hypoparathyroidism.

A 13-year-old girl presented with malabsorption which was ascribed to intestinal lymphangiectasia. Three years later a generalised seizure resulted from hypocalcaemia that was shown to be due to hypoparathyroidism during investigation of which toxic copper accumulation was recognised. The chance occurrence of three rare conditions is extremely remote making intestinal lymphangiectasia likely as the primary pathology. It is suggested that chronic intestinal loss of the copper-carrying caeruloplasmin resulted in toxic parathyroid deposition of copper leading to hypoparathyroidism with consequent hypocalcaemic seizure.

Adolescent↗