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Case 40: Recurrent Abdominal Pain and Diarrhoea
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
Serological tests to identify coeliac disease, such as anti-transglutaminase antibodies, anti-endomysial antibodies and total serum IgA levels should be sent. An HIV test should also be taken. If malabsorption is suspected, it would be prudent to check vitamin B12, folate and iron levels as these may need to be corrected.
Palmoplantar psoriasis
Published in M. Alan Menter, Caitriona Ryan, Psoriasis, 2017
Dario Kivelevitch, Bobbak Mansouri, M. Alan Menter
A recent study also found anti-gliadin and anti-transglutaminase antibodies in 18% and 10% of PPP patients, respectively. Only 6% of the patients were diagnosed with celiac disease, although those patients with positive titers of any of the antibodies showed significant improvement after following a gluten-free diet.62 In contrast, a German study was unable to find the same gluten intolerance association.63
Diagnostic and therapeutic challenge of unclassifiable enteropathies with increased intraepithelial CD103+ CD8+ T lymphocytes: a single center case series
Published in Scandinavian Journal of Gastroenterology, 2021
Christina Hartl, Jürgen Finke, Peter Hasselblatt, Wolfgang Kreisel, Annette Schmitt-Graeff
A retrospective analysis of patients with UEP treated at the Department of Medicine II at the Medical Center - University Hospital Freiburg, Germany, between December 2005 and March 2019 was performed. Patients with chronic diarrhea and increased IELs in duodenal biopsies were included. Patients with CD, PID, secondary immunodeficiencies (e.g., HIV infection), intake of medications such as olmesartan, or infectious diseases causing lymphocytic duodenitis or villous atrophy (e.g., Gardiasis, Whipple’s disease) were excluded [8]. All patients had negative IgA-type anti-transglutaminase-antibodies and normal IgA-serum levels. Since AIE is notoriously difficult to diagnose, we also included patients with suspected AIE. Patient characteristics, clinical, laboratory and treatment data were obtained from the computerized hospital information system and medical records.
Alveolar hemorrhage due to marijuana smoking using water pipe made with plastic bottle: case report and narrative review of the literature
Published in Inhalation Toxicology, 2021
Ségolène Toquet, Joël Cousson, Nathalie Choiselle, Claire Gozalo, Delphine Giusti, Firouze Bani-Sadr, Yohan N’Guyen
Besides supplemental oxygen administered at 6 l/min in intensive care unit, a treatment by prednisone 1 mg/kg/d was prescribed in association with levofloxacin. This latter was withdrawn 4 d later, once negative results were obtained from bacteriological analyses (see below). Supplemental oxygen requirements decreased rapidly (Figure 1(D)). Bronchoalveolar lavage (BAL) performed the third day yielded fluid becoming progressively bloody suggestive of AH (Golde score 34). Neither virus, bacteria, fungi nor malignant cells were detected in BAL fluid. Antineutrophils cytoplasmic, anti-glomerular basement membrane and anti-transglutaminase antibodies were all negative. Serum alpha-1 antitrypsin levels were 270 mg/dL. Congestive heart failure was ruled out by transthoracic echocardiography and the diagnosis of AH due to inhaled toxic compound was presumed. Screening for drugs and their metabolites in urine samples using gas chromatography/mass spectrometry evidenced only THC-COOH (degradation product of tetrahydrocannabinol [THC]) and para-methoxyphenylpiperazine metabolite but it ruled out the presence of benzylecgonine (cocaine degradation product). No other exposure to environmental toxic compound was evidenced after careful questioning of the patient.
Type 1 diabetes, thyroid, gastric and adrenal humoral autoantibodies are present altogether in almost one third of adult celiac patients at diagnosis, with a higher frequency than children and adolescent celiac patients
Published in Scandinavian Journal of Gastroenterology, 2020
Claudio Tiberti, Francesca Panimolle, Raffaele Borghini, Monica Montuori, Chiara Maria Trovato, Tiziana Filardi, Andrea Lenzi, Antonio Picarelli
A total of 92 adult celiac patient sera at disease diagnosis (69 females, 23 males; age range 18–50 years, median age 34.5 years) collected between 2010 and 2018 at the Department of Internal Medicine and Clinical Specialties and at the Department of Pediatrics, “Sapienza” University of Rome, were analyzed. At the moment of the sera collection all the CD patients recruited in the study were on a gluten-containing diet. A total of 68 (73.9%) CD patients presented symptoms of disease at diagnosis, including both gastrointestinal and extraintestinal manifestations, whereas 24 (26.1%) patients were asymptomatic (2 subjects identified by serological screening and 22 first degree CD relatives). All the subjects enrolled in the study were screened and found positive for presence of IgA-anti-transglutaminase antibodies (IgA-tTgAb) and underwent intestinal biopsies to confirm CD diagnosis. Exclusion criteria were potential CD and previous diagnosis of one or more of the four organ-specific disease investigated. Data from CD patients were compared to data from 237 adult healthy subjects (CTRL) (125 females, 122 males; age range 18.9–75.0 years, median age 40.6 years) collected between 2010 and 2018 at Department of Experimental Medicine, “Sapienza” University of Rome. The study was approved by the Ethical Committee of “Sapienza” University of Rome.