Protein Loss Enteropathy as an Initial Presentation of Gastric Epstein–Barr Virus Lymphoma

Protein loss enteropathy (PLE) is a complex disease process that can result in potentially fatal protein losses. Gastrointestinal protein losses usually arise from damage to the gastrointestinal mucosa or from lymphatic obstruction. The goal of management is to identify and treat the underlying causes and maintain normal serum protein levels. Here, we present a patient with diarrhea and generalized edema, with decreased serum albumin and gamma-globulin levels, concerning for protein loss enteropathy. He was ultimately found to be positive for HIV infection, and his stool alpha-1 antitrypsin levels were diagnostic of protein loss enteropathy. His endoscopic and histologic evaluation revealed gastric Epstein–Barr virus-encoded small RNA- (EBER-) positive lymphoma. Though gastrointestinal lymphomas are known to cause PLE, this will be the first documented case of EBER-positive gastric lymphoma presenting with PLE. We hope to bring awareness to this unique presentation to aid in expedient diagnosis and treatment to avoid delays in treatment and potentially fatal outcomes.