BACKGROUND: Primary intestinal lymphangiectasia (Waldmann's disease) is a rare 
disease characterized by dilated lymphatics in the small bowel leading to an 
exudative enteropathy with lymphopenia, hypoalbuminemia and 
hypogammaglobulinemia.
CASE PRESENTATION: We report the case of a 23 year-old male who presented with 
chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A 
low-fat diet along with nutritional therapy with medium-chain triglyceride 
supplementation improved the protein-losing enteropathy, but did not solve the 
anemia. Octreotide was also unsuccessful, and after attempting angiographic 
embolization therapy, limited small bowel resection together with antiplasmin 
therapy managed to correct the anemia and control the exudative enteropathy.
CONCLUSIONS: Although primary intestinal lymphangiectasia is usually adequately 
managed by nutritional therapy, complications such as anemia can occur and can 
prove to be a therapeutic challenge.