Hypocalcaemic seizures as a manifestation of protein-losing enteropathy in Crohn disease – case report

Crohn's disease is an idiopathic, chronic inflammatory disorder of the bowel, characterised by periods of activity and remissions, that involves any region of the gastrointestinal tract. Malabsorption syndrome may be a leading manifestation of Crohn's disease. The inflammatory process leads to ulcerations in the wall of the intestine. Destruction of the mucosa impairs absorptive and epithelial regenerative functions within the affected areas. This damage may lead to protein-losing enteropathy and chronic intestinal failure. We describe a case of a 15-year-old female patient with chronic hypocalcaemia and hypoalbuminaemia caused by protein-losing enteropathy due to Crohn's disease, without typical gastrointestinal symptoms. Parenteral nutrition had to be started because of progressive loss of weight and persistent electrolyte abnormalities. Laboratory studies revealed increased concentration of faecal alpha(1)-antitrypsin. Differential diagnosis of protein-losing enteropathy was made. In this case the results of many repeated gastroscopy and colonoscopy examinations were normal. Diagnostic laparotomy had to be performed; it revealed severe regional inflammatory changes of the intestine, typical of Crohn's disease, histopathologically confirmed, that required partial intestinal resection.