Protein-losing Enteropathy in Association with Right Heart Failure

Takanobu Hirosawa¹, Kazuhito Hirata^1, and Wake Minoru²

¹Division of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan

²Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan

Cite this paper:
Takanobu Hirosawa, Kazuhito Hirata and Wake Minoru. Protein-losing Enteropathy in Association with Right Heart Failure. American Journal of Medical Case Reports. 2016; 4(12):389-392. doi: 10.12691/ajmcr-4-12-5

Abstract

A 65-year-old woman, with past history of mitral valve replacement, developed severe right heart failure. In addition to elevated right heart pressure, she had significant hypoalbuminemia as the important cause of refractory edema. Technetium-99m-labelled human serum albumin scintigraphy showed leak of protein from the transverse colon and the excretion of alpha 1 antitrypsin in the stool was markedly increased. Diagnosis of protein losing enteropathy was established. The etiology was increased lymphatic pressure secondary to right heart failure of multifactorial cause, including elevated left side filling pressures and out of proportion pulmonary hypertension due to old tuberculosis, resulting in significant tricuspid regurgitation. The patient was managed conservatively with increased dose of furosemide from 10-20mg every other day up to 40-60mg/day, and maximum dose of tolvaptan (a vasopressin 2 receptor blocker) of 15mg/ day, in addition to high protein diet.

Keywords:
protein losing enteropathy right heart failure tolvaptan

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