PMC5577087_01
99mTc-labeled human serum albumin scintigraphy showing 2-hourly images of albumin leakage prior to treatment (A-D) and after treatment (E-H). Radioactivity accumulation was detected in the stomach (white triangle) at 2 and 4 hours (A, B) and in the intestine (black arrow) at 6 and 24 hours (C, D) after injection of the radioisotope. No abnormal radioactivity was detected at any time point.
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To clarify the cause of hypoalbuminemia, the gastrointestinal tract was examined. 99mTc-labeled human serum albumin scintigraphy (99mTc-HAS) showed accumulation of the radioisotope in the stomach after 2 and 4 hours and in the intestine after 6 and 24 hours (Fig. 1). With this treatment, the albumin leakage detected by 99mTc-HAS disappeared (Fig. 1), and the serum albumin level returned to the normal range.
An endoscopic examination showing edematous changes in the gastric mucosa.
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An endoscopic examination revealed edematous findings in the gastric mucosa (Fig. 2) but no significant findings in the intestinal tract.
A biopsy specimen from the stomach showing lymphocytes and plasma cells infiltrating mainly the gastric lamina propria (Hematoxylin and Eosin staining, scale bar=100 mum).
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A histopathological examination of the gastric wall tissue indicated infiltration of lymphocytes and plasma cells without lymphangiectasis or immune complex deposition (Fig. 3).
The clinical course of the patient after administration of prednisolone (PSL).  Skin eruptions and thrombocytopenia ascribable to the adverse event of azathioprine (AZA). mPSL: methylprednisolone pulse therapy, CsA: cyclosporin A
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The hypoalbuminemia persisted even after PSL was administered at a dose of 50 mg daily, suggesting that PSL alone was incapable of suppressing the disease activity (Fig. 4).