Application of technetium-99m-labeled human serum albumin scan to assist surgical treatment of protein-losing enteropathy in Cronkhite-Canada syndrome: report of a case

Applicability of 99m Tc-Labeled Human Serum Albumin Scintigraphy in Dogs With Protein-Losing Enteropathy

Background

Diagnosis of protein loss into the gastrointestinal tract using noninvasive techniques is challenging. In people, scintigraphy not only is a sensitive tool to confirm protein‐losing enteropathy (PLE), but it also allows for localization of protein loss.

Hypothesis/Objectives

To investigate the feasibility of ^99mTc‐labeled human serum albumin (HSA) scintigraphy in dogs with PLE in comparison with control dogs.

Animals

A total of 8 clinically healthy control research dogs and 7 client‐owned dogs with gastrointestinal clinical signs and hypoalbuminemia (serum albumin concentration <2.0 g/dL).

Methods

Prospective case–control study. After IV injection of 400 MBq freshly prepared ^99mTc HSA (30 mg/dog), images of the abdomen were obtained 10, 60, 120, and 240 minutes postinjection. Additional images of the salivary and thyroid glands were obtained to rule out free ^99mTc. A scan was considered positive for PLE when radiopharmaceutical exudation was detectable in the intestinal tract.

Results

Only 1 control dog showed exudation of the radiopharmaceutical into the intestinal tract. No free ^99mTc was detected in any dog. In dogs with PLE, focal small intestinal and diffuse small intestinal radiopharmaceutical exudation into the bowel was detected in 2 and 3 dogs, respectively, whereas in 2 dogs, there was disagreement about whether radiopharmaceutical exudation was focal or diffuse.

Conclusion and Clinical Importance

^99mTc‐labeled HSA scintigraphy was feasible to diagnose PLE in dogs.

Cronkhite-Canada syndrome: a report of one case

Cronkhite-Canada syndrome (CCS) is a rare clinic entity of unknown etiology and has poor prognosis, characterized by gastrointestinal polyposis with ectodermal changes. Main clinical manifestations include chronic diarrhea, abdominal pain, alopecia, skin pigmentation, and nail changes. Here, we report a case of CCS in a 50-year-old male and review the relevant literature.

Outcome of surgical resection for protein-losing enteropathy in systemic lupus erythematosus

Protein-losing enteropathy (PLE) is an uncommon manifestation associated with systemic lupus erythematosus (SLE). Here, a case with SLE and concomitant hypoalbuminemia is reported. Technetium-99m albumin scintigraphy demonstrated a localized lesion in the ascending colon, and the diagnosis of SLE-related PLE was established. Due to a poor response to medical treatment, this patient received surgical resection, but relapse still developed later on. Recurrent protein-lose from the remaining of the colon was documented by repeated images. This report discusses the management of SLE-related PLE and the role of nuclear medicine scintigraphy in the investigation of PLE.