A case of Cronkhite-Canada syndrome presenting with adenomatous and inflammatory colon polyps.

BACKGROUND

A 72-year-old man was referred for evaluation of dysgeusia, diarrhea and anorexia. 3 months prior he began to experience taste changes, a decline in appetite and 3-7 loose, non-bloody stools per day. Nausea and lower abdominal cramping subsequently developed and he lost 22.68 kg in weight. His past medical history included atrial fibrillation treated with anticoagulation and digoxin. In the past, he had experienced markedly increased levels of triglycerides and was being treated for this condition with a lipid-lowering agent. There was no family history of colorectal neoplasia or IBD. He was a non-smoker and did not drink alcoholic beverages.

INVESTIGATIONS: Medical history, physical examination, laboratory evaluation (including 72 h stool collection), upper endoscopy, colonoscopy and histologic analysis of biopsy samples.

DIAGNOSIS: Cronkhite-Canada syndrome.

MANAGEMENT: Prednisone (40 mg orally once daily, eventually tapered to 10 mg orally once daily), a histamine-2-receptor blocker and oral micronutrient supplementation (iron, vitamins A, E and D and a multivitamin). Removal of all visible polyps from the anal verge to 25 cm endoscopically by snare polypectomy or with hot biopsy forceps, followed by subtotal colectomy with end-to-side ileorectostomy.