[PAGID] Autoinmmune enteropathy?

[Nacho Gonzalez]

normal stool D/R. worm infestations ruled out

Nacho Gonzalez Granado


2009/8/10, Sabiha Anis <sabiha_anis at hotmail.com>:

>

> What are the results of stool D/R.  Have you ruled out worm infestations?

>

> Regards

> Sabiha anis

>

> ------------------------------

> Date: Fri, 7 Aug 2009 14:00:55 +0200

> From: nachgonzalez at gmail.com

> To: pagid at list.clinimmsoc.org

> Subject: [PAGID] Autoinmmune enteropathy?

>

>  7 year old female (RM)  with severe chronic diarrea with neonatal onset.

> Cuacasian. She has persistent malabsortion. She required parenteral

> nutrition when she was eighteen month old (for severe malnutrition).

> Intestinal biopsy (2002): moderate partial vellous atrophy.

>

>

>

> Her sister (AM) suffers from refractory celiac disease (CD) with persistent

> antigliadin and antitransglutaminase positive despite strictly gluten free

> diet.

>

>

>

> The patient (RM) presents negative celiac serology. HLA is not compatible

> with celiac disease.  Intraepitelial lymphocytes are not compatible with

> CD (in 2002 and now). Antienterocyte antibodies are also negative (in 2002

> and now).  CD25+ and FOXP3+ are in normal  range (this month). She has

> persistent IgE elevation (around 1000 IU/mL). Anti TPO levels were slightly

> elevated once (Dec´08) but now are in normal range. Anti PCA (parietal cell

> antibodies are slightly positive: 1/80 ) ANA + 1/40 (normal) .  We have

> ruled out food allergies.  IgG,A,M normal. Lymphocyte subpopulations:

> normal.

>

> She is now admitted for severe diarrhea and malnutrition.

>

>

>

> We are not sure about starting steroid therapy. We'd really appreciate

> helpful suggestions about diagnosis and treatment.

>

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