S5098 Cronkhite-Canada Syndrome: A Rare Presentation for Weight Loss, Diarrhea and Protein-Losing Enteropathy
Bibliographic record
Abstract
Introduction: Cronkhite-Canada syndrome (CCS) is a rare, nonhereditary polyposis syndrome that causes protein-losing enteropathy, weight loss, diarrhea, and skin changes. Around 500 cases have been documented worldwide in 50 years. CCS is difficult to diagnose and many patients fail therapy and have high morbidity and mortality. We report CCS in a 62-year-old Asian man. Case Description/Methods: A 62-year-old healthy man presented with several weeks of bloating, loss of smell and taste, decreased appetite, diarrhea, darkened hands, and fingernail splitting (Figure) following a screening colonoscopy, which showed 3 small benign polyps. He also endorsed 50 pounds of weight loss over 3 months. Extensive investigation of infectious, neoplastic, and inflammatory causes was negative. Stool was positive for occult blood. He developed hypoproteinemia and markedly elevated calprotectin level to 4,260 μg/g. Endoscopy and repeat colonoscopy was performed with endoscopic ultrasound. This showed thickened polypoid folds in the stomach (Figure), duodenum, and colon. Pathology revealed edematous lamina propria and cystically dilated glands throughout the gastrointestinal tract (Figure 1). A diagnosis of CCS was made. The patient was started on prednisone plus mesalamine and a high-calorie, high-protein diet. In 3 months, he gained 20 pounds, and all of his symptoms improved. He continues to be followed by gastroenterology. Discussion: CCS is rare. Most reported cases are from Asia. The etiology is unknown, but an autoimmune etiology has been purported due to positive responses to immunosuppression. Diagnosis combines clinical features of chronic diarrhea, weight loss, malnutrition, and skin changes with multiple hamartomatous polyps in the gastrointestinal tract. Management is primarily immunosuppression with glucocorticoids with or without 5-aminosalicylates. CCS can lead to complications, including infections and blood clots, and increased risk of gastrointestinal cancers. Nutritional support is crucial. Regular upper and lower endoscopies are important to monitor malignant complications. CCS is progressive with a poor prognosis. Given its rarity, prospective data on management is limited, and there are no guidelines for monitoring. This case shows how prompt diagnosis and multifaceted management for this rare syndrome can improve symptoms and disease control and encourages further studies to improve management.Figure 1.: A-Darkened hands and fingernail splitting. B-Image of the stomach obtained during endoscopy shows thickened polypoid folds with edema and inflammation. C-On hematoxylin and eosin staining, the stomach shows polypoid architecture, cystically dilated glands, and edematous lamina propria.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".