Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: A diagnostic challenge?

2014 ◽  
Vol 12 (4) ◽  
pp. 401-405 ◽  
Author(s):  
Marijke C.C. Langenberg ◽  
Pieter J. Wismans ◽  
Perry J.J. van Genderen
Keyword(s):  
Celiac Disease ◽  
Tropical Sprue ◽  
Chronic Diarrhoea ◽  
Diagnostic Challenge ◽  
Returning Travellers

scholarly journals Dual threat of comorbidity of celiac disease and systemic lupus erythematosus

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110122
Author(s):  
Yimin Ma ◽  
Duanming Zhuang ◽  
Zhenguo Qiao
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Celiac Disease ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Failure To Thrive ◽  
Severe Malnutrition ◽  
Systemic Lupus ◽  
Electrolyte Disorders ◽  
Diagnostic Challenge ◽  
Immune Mediated

Celiac disease (CD) is a chronic immune-mediated intestinal disease that is characterized by production of autoantibodies directed against the small intestine. The main clinical manifestations of CD are typically defined as those related to indigestion and malabsorption. These manifestations include unexplained diarrhea or constipation, abdominal pain, bloating, weight loss, anemia, failure-to-thrive in children, and decreased bone density. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by heterogeneous clinical manifestations, which may also involve the gastrointestinal tract. Comorbidity of CD and SLE is rare, and the overlapping symptoms and nonspecific clinical presentation may pose a diagnostic challenge to clinicians. We report here a case of SLE with CD, which mainly manifested as recurrent diarrhea, uncorrectable electrolyte disorders, and severe malnutrition. Through review, we hope to further improve our understanding and diagnostic level of this combination of diseases.

Celiac disease A diagnostic challenge with many facets

2002 ◽  
Vol 2 (6) ◽  
pp. 293-305 ◽  
Author(s):  
Stefano Guandalini ◽  
Puneet Gupta
Keyword(s):  
Celiac Disease ◽  
Diagnostic Challenge

scholarly journals Intravascular Lymphoma in Patient With Celiac Disease With Multi Glandular Involvement

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A938-A939
Author(s):  
Mustafa Alam ◽  
Mohamad Hosam Horani
Keyword(s):  
Celiac Disease ◽  
B Cell ◽  
Cell Lymphoma ◽  
Case Reports ◽  
B Cell Lymphoma ◽  
Diagnostic Challenge ◽  
Pituitary Microadenoma ◽  
Non Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
History Of

Abstract Case Presentation: The patient is a 60 year old male with a past medical history of celiac disease, paroxysmal Afib, iron deficiency, and CAD who presented with lightheadedness, dizziness, and fatigue. Notable workup revealed that the patient had Afib with RVR, a TSH of 0.189, Free t4 0.51an LDH of 2726, hemoglobin of 8.7, AST of 155, ALT of 19, WBC of 4.5, and serum iron of 20. The patient’s cardizem dose was adjusted and repeat transthoracic echocardiogram was unremarkable compared to history. The patient presented again with complaints of abdominal distension, postural dizziness, occasional night sweats, and fevers. Repeat workups revealed pancytopenia, proteinuria, hypotension, and anasarca most pronounced in the lower extremity and scrotum. Ultimately, a kidney biopsy revealed an intravascular B cell non-Hodgkin lymphoma (IVBCL). Notable repeat labs include a CRP of 44 and a failed ACTH stimulation test. A brain MRI revealed a 6mm pituitary microadenoma. The patient placed on an R-CHOP regiment and is scheduled for repeat MRI to rule out pituitary involvement. Discussion: IVBCL’s are a rare form of diffuse B cell lymphoma and remain a diagnostic challenge due to the variety of involved systems including skin, CNS, and endocrine. IVBCL is also known to not produce a mass or lymphadenopathy. Celiac disease is a known risk factor for non-Hodgkin’s lymphoma. A literature search reveals a few case reports with common themes of increased LDH and inflammatory markers, anemia, and hepatic and renal dysfunction. Postural hypotension can also be a presenting symptom due to IVBCL’s ability to infiltrate neurovascular tissue to cause autonomic neuropathy. However, in this case, the patient’s history of primary adrenal insufficiency makes this unlikely. Hypothyroidism secondary to pituitary and thyroid involvement was suspected due to TSH level suppressed enough for central hypothyroidism. Repeated MRI showed resolution of Pituitary Microadenoma post Chemo therapy. Sylvain Raoul Simeni Njonnou, Bruno Couturier, Yannick Gombeir, Sylvain Verbanck, France Devuyst, Georges El Hachem, Ivan Theate, Anne-Laure Trepant, Virginie De Wilde, Frédéric-Alain Vandergheynst, “Pituitary Gland and Neurological Involvement in a Case of Hemophagocytic Syndrome Revealing an Intravascular Large B-Cell Lymphoma”, Case Reports in Hematology, vol. 2019, 6 pages, 2019. https://doi.org/10.1155/2019/9625075 Catassi C, Fabiani E, Corrao G, et al. Risk of Non-Hodgkin Lymphoma in Celiac Disease. JAMA. 2002;287(11):1413 Khan MS, McCubbin M, Nand S. Intravascular Large B-Cell Lymphoma: A Difficult Diagnostic Challenge. J Investig Med High Impact Case Rep. 2014 Mar 6;2(1):2324709614526702. Pearce C, Hope S, Butchart J. Intravascular lymphoma presenting with postural hypotension. BMJ Case Rep. Published 2018 Jan 29.

Malabsorption syndromes in the tropics

2020 ◽  
pp. 2916-2924
Author(s):  
Vineet Ahuja ◽  
Govind K. Makharia
Keyword(s):  
Symptomatic Relief ◽  
Epidemiological Data ◽  
Strongyloides Stercoralis ◽  
Tropical Sprue ◽  
Nutritional Deficiencies ◽  
Chronic Diarrhoea ◽  
Industrialized Countries ◽  
Malabsorption Syndromes ◽  
Immunoproliferative Small Intestinal Disease ◽  
The Tropics

Causes of secondary malabsorption that are most common in the tropics include (1) progressive wasting in people infected with HIV, which is known as ‘slim disease’; (2) various infections—protozoal (e.g. Giardia lamblia, Cryptosporidium parvum), helminthic (e.g. Capillaria philippinensis, Strongyloides stercoralis), and bacterial (Mycobacterium tuberculosis); (3) immunoproliferative small intestinal disease; and (4) hypolactasia. Coeliac disease and Crohn’s disease also occur. When patients with conditions that can cause secondary malabsorption are excluded, a group remains who have chronic diarrhoea, malabsorption, and its nutritional sequelae. This primary or idiopathic malabsorption syndrome is called ‘tropical sprue’, which occurs against the background of tropical enteropathy (describing the fact that the morphology of the mucosa of normal gut is different in tropical preindustrialized countries from that in temperate-zone industrialized countries). The aetiology of tropical sprue is not known: epidemiological data suggests an infective cause, but no causal agent has been identified. Presentation is typically with loose or watery stools lasting for several weeks or months, and with symptoms and signs of nutritional deficiency. Management involves symptomatic relief from diarrhoea, and correction of fluid and electrolyte abnormalities and nutritional deficiencies. Attempts at specific curative measures—folic acid and tetracyclines—are usually given for up to 6 months.

Percutaneous Ultrasound Guided Cholecystocentesis and Microbiological Analysis of Bile in Chronic Diarrhoea of Cattle

2020 ◽  
Author(s):  
Arati Hansda ◽  
C. S. Randhawa ◽  
M. Chandra ◽  
J. Mohindroo ◽  
S. S. Randhawa
Keyword(s):  
Chronic Diarrhoea ◽  
Large Animal ◽  
Microbiological Analysis ◽  
Crossbred Cattle ◽  
Ultrasound Guided ◽  
Serum Samples ◽  
Diagnostic Challenge ◽  
Salmonella Spp ◽  
Isolation And Identification ◽  
Bile Samples

Background: Chronic diarrhoea is a frequently presenting complaint by the cattle owners and some presents as non-responsive to routine treatment. Such cases are often a diagnostic challenge because of wide ranging etiologies. In Indian context few data is available on prevalent causes of chronic diarrhoea in bovines. Salmonellosis is one of the important cause of chronic diarrhoea in crossbred cattle. Therefore, the study was conducted to investigate the role of Salmonella in chronic diarrhoea of crossbred cattle and to determine microbiological profile of bile in cattle with chronic idiopathic diarrhoea. Methods: Twenty (n=20) adult dairy cattle presented with the history of chronic diarrhoea at Large Animal Clinics, GADVASU, Ludhiana from September 2015 to June 2016 were selected for the study. Case histories were recorded, faecal, blood and bile samples were collected from 20 animals. Bile was collected through ultrasound guided cholecystocentesis (PUC) from 20 cattle and five healthy cattle. The faecal and bile samples were cultured for isolation and identification of bacterial pathogens using selective and non-selective media with special emphasis on isolation of Salmonella spp. Microscopic examination of faeces were done to rule out parasitic cause of diarrhoea and for acid-fast bacilli (AFB). The serum samples were employed to detect antibodies against Mycobacterium avium spp paratuberculosis using serum ELISA. Result: Investigations have showed culture of bile and faecal did not yield Salmonella spp; however E.coli was isolated from 6 cows (30%), Klebsiella spp in 9 cows (45%) and Pseudomonas spp from 1 cow (5%) from bile culture of diarrhoeic cattle. PCR results of E.coli culture from bile showed hlyA virulence genes which expected band at 534 bp however these isolates were negative for other virulence gene of E.coli. It was observed in this study that bactibilia was associated with chronic diarrhoea in three fourth of the diarrhoeic cattle.

scholarly journals Tropical sprue: case report with review of literature

1970 ◽  
Vol 2 (3) ◽  
pp. 241-244
Author(s):  
W Robinson ◽  
B Bhattacharya
Keyword(s):  
Small Intestine ◽  
Case Report ◽  
South Asia ◽  
Clinical Information ◽  
Tropical Sprue ◽  
Review Of Literature ◽  
Diagnostic Challenge ◽  
Clinicopathological Findings

Tropical sprue is an important cause of malabsorption in adults and in children in South Asia. Investigations to exclude specific infective, immunological or inflammatory causes are important before considering tropical sprue as a diagnosis. Malabsorption disorders of the small intestine can be a source of great debilitation to the patient, and a diagnostic challenge to the pathologist. This article presents clinicopathological findings of a non coeliac tropical sprue in a 66–year-old male and discusses the histological and clinical information that can help differentiate coeliac from non coeliac sprue. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6030 JPN 2012; 2(3): 241-244

scholarly journals Celiac Disease in Bangladesh – Two Case Reports

2013 ◽  
Vol 37 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Md Rukunuzzaman ◽  
ASM Bazlul Karim ◽  
SM Baqui Billah ◽  
Md Atiar Rahman ◽  
Md Mahbubul Islam ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Screening Test ◽  
Villous Atrophy ◽  
Case Reports ◽  
Growth Failure ◽  
Gluten Free Diet ◽  
Chronic Diarrhoea ◽  
Gluten Free ◽  
Immunological Disorder ◽  
Rule Out

Celiae disease is an immunological disorder precipitated by gluten in genetically susceptible persons. Its prevalence is not known in Bangladesh because of unavailability of its screening test. There is diversity in the presentation of celiac disease. Two children of 5 and 8 years of age who were diagnosed as celiac disease are reported here. One presented typically with chronic diarrhoea & growth failure. Another child presented with features of chronic liver disease. In both the cases IgA tTGA were positive and duodenal biopsy showed villous atrophy. After diagnosis, both the patients were kept on gluten free diet (GFD). After six months of GFD, IgA tTGA came down to normal in both the cases. They were then given gluten containing diet again & after few months IgA tTGA again raised in both the cases. Thereafter the cases were finally diagnosed as celiac disease and were advised life long gluten free diet. Celiac disease is not uncommon in Bangladesh and screening test should be done to diagnose or rule out celiac disease when there is a suspicion. DOI: http://dx.doi.org/10.3329/bjch.v37i1.15351 BANGLADESH J CHILD HEALTH 2013; VOL 37 (1) : 45-48

scholarly journals Seronegative Intestinal Villous Atrophy: A Diagnostic Challenge

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Cláudio Martins ◽  
Cristina Teixeira ◽  
Suzane Ribeiro ◽  
Daniel Trabulo ◽  
Cláudia Cardoso ◽  
...  
Keyword(s):  
Weight Loss ◽  
Celiac Disease ◽  
Chronic Diarrhea ◽  
Villous Atrophy ◽  
Gluten Free ◽  
Diagnostic Challenge ◽  
Drug Induced ◽  
High Index Of Suspicion ◽  
Involuntary Weight Loss ◽  
Intraepithelial Lymphocytosis

Celiac disease is the most important cause of intestinal villous atrophy. Seronegative intestinal villous atrophy, including those that are nonresponsive to a gluten-free diet, is a diagnostic challenge. In these cases, before establishing the diagnosis of seronegative celiac disease, alternative etiologies of atrophic enteropathy should be considered. Recently, a new clinical entity responsible for seronegative villous atrophy was described—olmesartan-induced sprue-like enteropathy. Herein, we report two uncommon cases of atrophic enteropathy in patients with arterial hypertension under olmesartan, who presented with severe chronic diarrhea and significant involuntary weight loss. Further investigation revealed intestinal villous atrophy and intraepithelial lymphocytosis. Celiac disease and other causes of villous atrophy were ruled out. Drug-induced enteropathy was suspected and clinical improvement and histologic recovery were verified after olmesartan withdrawal. These cases highlight the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of sprue-like enteropathy.

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