A 69-year-old man was admitted for a second opinion concerning swelling of the ankles and hypoalbuminaemia of 1.5 years' duration. He denied having diarrhea, weight loss, night sweats, and fever. Once proteinuria was excluded and liver synthesis function proved normal, a protein-losing enteropathy was suspected. Upper and lower GI series and an abdominal CT scan did not reveal any abnormalities, and duodenal biopsy results showed normal villous architecture.
Video capsule endoscopy (VCE) showed multiple small white nodes and larger polypoid nodes surrounded by macroscopically normal mucosa extending from the proximal jejunum to the terminal ileum, as well as a possible stenosis in the mid small bowel (Fig. 1). Neither ulceration nor villous atrophy was observed. Subsequently, a magnetic resonance imaging (MRI) enteroclysis was performed, which confirmed stenosis of the mid jejunum and revealed wall thickening, borderline enlarged mesenteric lymph nodes, and slight infiltration of the mesenteric fat