We extirpated a large popliteal cyst in an RA-complicated rare case of intestinal lymphangiectasia which is a representative disease among protein losing gastroenteropathies.
The patient was a 57-year-old female whose chief complaint was a painful tumor formation in the left leg. She had begun to suffer from swelling and pain in both hands in 1971 that was diagnosed as RA. Edema of both legs developed in 1979, and subsequent swelling of the abdominal region was diagnosed as intestinal lymphangiectasia. Moreover, a cyst formed in the back of the left hand in 1981 and was relieved by curettage. Swelling and pain on the posterior surface of the left leg occurred in 1982. It did not decrease with puncture treatment, and she was admitted to our hospital in October, 1983. At that time ulner deviation of fingers on both hands, Swanneck deformity, and deformities of anterior feet, and also swelling of the left leg and restriction of the ROM of the left knee joint were noted. Test findings showed serum total protein had decreased remarkably to 3.3g/dl, and a round cystic pattern with a major axis of 25cm was noted in the posterior surface of the left leg by arthorography of the left knee. IVH was conducted for 1 month, and the operation was postponed until the serum total protein had raised to 4.4g/dl. After extirpation of the large cyst on the posterior surface of the left leg, an operation was performed which included left knee joint synovectomy. At present, 2 years later, no recurrence of pain has been noted, and a normal gait has become possible.
This case is thought to be an extremely rare one of complicated intestinal lymphangiectasia due to RA, and hypoproteinemia due to the intestinal lymphangiectasia is assumed to be responsible for the formation of the large cyst.
