AHCD

• Usually occurs in residents or immigrants from Mediterranean or Middle East; associated with low socio-economic group, poor hygiene, recurrent infectious diarrhoea and chronic parasitic infection.

• Commonly presents with diarrhoea, steatorrhoea, weight loss, abdominal pain and vomiting; a-HCD protein detectable in serum of most patients, concentration often low; mild to moderate anaemia; low serum albumin; hypokalaemia and hypocalcaemia (tetany); infiltrative lesions in duodenum and jejunum in most patients; histology ranges from lymphoplasmacytic infiltration of mucosa (Stage A) to immunoblastic lymphoma invading entire intestinal wall.

288 • Progressive course without treatment; treat Stage A initially with oral metronidazole and tetracycline for 6 months; treat non-responders and Stage B or C with CHOP-type regimen.

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