Jejunoileal Bypass Surgery and Granulomatous Disease of the Kidney and Liver

A 26-year-old woman, who had undergone jejunoileal bypass surgery six years previously for obesity, had symptoms of intermittent fever, myalgia, polyarthralgia, and aseptic joint swelling. These symptoms commenced one year after her surgery and gradually grew in intensity and frequency of occurrence. The patient, observed to have moderately decreased renal function, hyperoxaluria, and circulating cryoglobulins, underwent liver and renal biopsies. Both organ specimens demonstrated granulomatous involvement, but the kidneys exhibited no evidence of oxalate deposition. The findings of circulating cryoglobulins and suppression of symptoms with doxycycline, taken collectively with the circumstances surrounding this case, suggest that the observed granulomatous disease may be due to systemically adsorbed bacterial antigen(s).