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An unusual method of diagnosing a common disease
A 34-year-old woman presented with non-bloody diarrhoea of 14 days duration and vomiting. Physical examination was unremarkable. She had hypokalaemia and metabolic acidosis. Stool studies were negative for Clostridium difficile toxin, faecal leucocytes and parasites. Colon appeared normal on colonos...
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| Published in: | BMJ case reports 2012-11, Vol.2012, p.bcr2012006691 |
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| container_title | BMJ case reports |
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| creator | Khangura, Sajneet K von Rosenvinge, Erik C |
| description | A 34-year-old woman presented with non-bloody diarrhoea of 14 days duration and vomiting. Physical examination was unremarkable. She had hypokalaemia and metabolic acidosis. Stool studies were negative for Clostridium difficile toxin, faecal leucocytes and parasites. Colon appeared normal on colonoscopy. Pronounced scalloping of ileal folds was noted on ileoscopy. Ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the lamina propria, consistent with lymphocytic ileitis in coeliac disease. Serology revealed elevated antitissue transglutaminase IgA antibodies (>100 U/ml). Institution of a strict gluten free diet resulted in complete resolution of symptoms. Although rare, coeliac disease can present as an acute diarrhoeal illness and should be considered after infectious aetiologies are excluded. |
| doi_str_mv | 10.1136/bcr-2012-006691 |
| format | article |
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Physical examination was unremarkable. She had hypokalaemia and metabolic acidosis. Stool studies were negative for Clostridium difficile toxin, faecal leucocytes and parasites. Colon appeared normal on colonoscopy. Pronounced scalloping of ileal folds was noted on ileoscopy. Ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the lamina propria, consistent with lymphocytic ileitis in coeliac disease. Serology revealed elevated antitissue transglutaminase IgA antibodies (>100 U/ml). Institution of a strict gluten free diet resulted in complete resolution of symptoms. 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Physical examination was unremarkable. She had hypokalaemia and metabolic acidosis. Stool studies were negative for Clostridium difficile toxin, faecal leucocytes and parasites. Colon appeared normal on colonoscopy. Pronounced scalloping of ileal folds was noted on ileoscopy. Ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the lamina propria, consistent with lymphocytic ileitis in coeliac disease. Serology revealed elevated antitissue transglutaminase IgA antibodies (>100 U/ml). Institution of a strict gluten free diet resulted in complete resolution of symptoms. Although rare, coeliac disease can present as an acute diarrhoeal illness and should be considered after infectious aetiologies are excluded.</description><subject>Adult</subject><subject>Autoantibodies - blood</subject><subject>Biopsy</subject><subject>Bowel disease</subject><subject>Celiac disease</subject><subject>Celiac Disease - diagnosis</subject><subject>Celiac Disease - diet therapy</subject><subject>Celiac Disease - pathology</subject><subject>Colon</subject><subject>Diagnosis, Differential</subject><subject>Diarrhea</subject><subject>Diarrhea - etiology</subject><subject>Diet, Gluten-Free</subject><subject>Electrolytes</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Female</subject><subject>Humans</subject><subject>Ileitis - diagnosis</subject><subject>Ileitis - diet therapy</subject><subject>Ileitis - pathology</subject><subject>Ileum - pathology</subject><subject>Immunoglobulin A - blood</subject><subject>Intestinal Mucosa - pathology</subject><subject>Intubation</subject><subject>Lymphocytosis - diagnosis</subject><subject>Lymphocytosis - pathology</subject><subject>Unusual Presentation of More Common Disease/Injury</subject><subject>USA/Canada</subject><subject>Vomiting - etiology</subject><subject>White</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNqFkc1LAzEQxYMottSevcmCFxHWZjZfm4tQil9Q8KLgLWSz2XbLblI3XcH_3pTWol6cS4bJL483eQidA74BIHxSmC7NMGQpxpxLOEJDEEykQuK34x_9AI1DWOFYBGhOySkaZAQ4By6GCE9d0rs-9LpJWrtZ-jLxVVLWeuF8qN0i0YnxbetdnAWrgz1DJ5Vugh3vzxF6vb97mT2m8-eHp9l0nhZEMkg5BiNzAoLysqykFVLaXIDIC000LnCFOWOYZgU1JqNcWllxLYW1lLMqB0JG6Hanu-6L1pbGuk2nG7Xu6lZ3n8rrWv2-cfVSLfyHooxSkmVR4Gov0Pn33oaNautgbNNoZ30fFICQDJOcyIhe_kFXvu9cXE9FxyQTTEoRqcmOMp0PobPVwQxgtQ1ExUDUNhC1CyS-uPi5w4H__v4IXO-Aol39q_YFNByRoA</recordid><startdate>20121119</startdate><enddate>20121119</enddate><creator>Khangura, Sajneet K</creator><creator>von Rosenvinge, Erik C</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20121119</creationdate><title>An unusual method of diagnosing a common disease</title><author>Khangura, Sajneet K ; 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Physical examination was unremarkable. She had hypokalaemia and metabolic acidosis. Stool studies were negative for Clostridium difficile toxin, faecal leucocytes and parasites. Colon appeared normal on colonoscopy. Pronounced scalloping of ileal folds was noted on ileoscopy. Ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the lamina propria, consistent with lymphocytic ileitis in coeliac disease. Serology revealed elevated antitissue transglutaminase IgA antibodies (>100 U/ml). Institution of a strict gluten free diet resulted in complete resolution of symptoms. Although rare, coeliac disease can present as an acute diarrhoeal illness and should be considered after infectious aetiologies are excluded.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>23166167</pmid><doi>10.1136/bcr-2012-006691</doi><oa>free_for_read</oa></addata></record> |
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| source | Open Access: PubMed Central |
| subjects | Adult Autoantibodies - blood Biopsy Bowel disease Celiac disease Celiac Disease - diagnosis Celiac Disease - diet therapy Celiac Disease - pathology Colon Diagnosis, Differential Diarrhea Diarrhea - etiology Diet, Gluten-Free Electrolytes Endoscopy, Gastrointestinal Female Humans Ileitis - diagnosis Ileitis - diet therapy Ileitis - pathology Ileum - pathology Immunoglobulin A - blood Intestinal Mucosa - pathology Intubation Lymphocytosis - diagnosis Lymphocytosis - pathology Unusual Presentation of More Common Disease/Injury USA/Canada Vomiting - etiology White |
| title | An unusual method of diagnosing a common disease |
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