Abstract
In the following case report we present a case 54 year patients with type 2 diabetes type originally treated with a sulphonylurea hospitalized for a severe and prolonged hypoglycemic episode. Self- treatment of hypoglycemia was not interesting, but the search for the cause of development of the differential diagnosis of hypoglycemia was very interesting.
Some clinical symptoms of malabsorption syndrome were combined in a patient with prolonged subfebrile and knowing the patient's haematological malignancies were searched for possible infectious causes of diarrhea or progression of the underlying cancer. Performed cultivation examination and imaging methods eliminate these alternatives.
For existing anemia and gastrointestinal disorders was performed endoscopy of the upper GIT with finding lymfostázy in the small intestine. Differential diagnosis of intestinal lymphangiectasia -by offering the possibility of actively ongoing lymphoma , which the patient suffered, but nález cancer patient appeared to be stabilized.
Alternatively differential diagnosis was Whipple , which was histology sample mucosal tissue and confirmed by PCR. The emergence of hypoglycemic episodes in the treatment of established type 2 diabetes type associated with the development of malabsorption syndrome in Whipple's disease , which resulted in the decrease in weight of the patient and present a drastic reduction in insulin resistance patients.
In this situation, originally set them - adequacy treatment of diabetes in a patient led to the development of hypoglycemia. Malabsorption syndrome on the basis of lymphangiectasia intestinal mucosa in persons already treated for malignant lymphoma require exclusion of progression of the disease , but also with known immunodeficiency patient and the presence of seronegative arthritis forced to think about the possibility and Whipple's disease .