Cronkhite-Canada syndrome with adenomatous polyposis.

A 20-year-old man with no prior complaints presented with progressive hyper pigmentation for 8 months, intermittent loose stools, hematochezia and vague abdominal pain. He also had anorexia and weight loss of 8 kg over last 8-mo. There was no family history of polyposis. On physical examination, he was lean, pale, had generalized hyperpigmentation, onychodystrophy [Figure 1] and alopecia. Initial evaluation ruled out Addison’s disease as cortisol levels were normal. Lab tests revealed decreased Hb 113 g/L (normal 140-160), total protein 46 g/L (normal 55-85) and serum albumin 20 g/L (normal 35-55).