Diarrhea, Recurring Symptom Different Diagnosis

1University of Nebraska Medical Center, Omaha, NE

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 218

Case Presentation:

A 57‐year‐old while female presented with 9 weeks of diarrhea and abdominal pain. She characterized her stools as large volume and nonbloody. She had noticed an associated 20‐pound weight loss. She denied recent antibiotics, travel, camping, or ingestion of undercooked or raw foods. She is a lifetime nondrinker. On exam, she was tachycardic at 127. her blood pressure was 62M8 lying and 62/50 on standing, and she was afebrile. Her abdomen was soft yet diffusely lender; bowel sounds were present. There was mild pitting edema to her knees. No skin rash or lesions were noted. Labs revealed a mild nongap metabolic acidosis and low magnesium, phosphorus, and albumin. Stool studies were negative for Clostridium difficile, enteric pathogens, giardia, stool white blood cells, ova. and parasites. Her HIV and celiac panel were also negative. Computed tomography (CT) of the abdomen and pelvis showed diffuse enteritis of the small bowel and colon with no evidence of masses. Esophagogastroduodenoscopy (EGD) showed a villiform, edematous duodenum, wtiereas her flexible sigmoidoscopy (FS) was normal. Biopsies taken at the time of the EGD showed partial villous Hunting and increased crypt apoptotic bodies. The lamina propria was heavily inflamed with plasma cells and eosinophils. The colonic biopsies had similar but milder changes. Subsequently, testing for anlienterocyte antibodies was negative. Despite the negative antibody testing, it was thought that her case was most consistent with autoimmune enteropathy (AIE). She was started on prednisone and subsequently had rapid improvement in her symptoms prior To discharge. She has since completed a steroid Taper and remains symptom free.

Discussion:

Diarrhea is a common presenting symptom of patients to the hospital. Autoimmune enteropathy is a rare cause of intractable diarrhea in adults. Twenty‐six cases have been reported in the literature to date. Patients typically present with diarrhea, weight loss, and malnutrition. Initial workup should focus on ruling out infectious etiology, HIV, and celiac sprue. EGD may reveal villous blunting or scalloping of the duodenum. Small bowel biopsy shows characteristic changes of villous blunting, increased crypt apoptosis, and infiltration of the lamina propria with lymphocytes and eosinophils. The presence of antibodies to enterocytes and/or goblet cells is believed to be helpful but not diagnostic of AIE. Treatment of AIE requires immunosuppressive therapy in most cases. In the 26 reported cases, all but 4 had improvement in symptoms. Twenty of the responders needed steroids ± other immunosuppressants, 1 responded following resection of a thymoma, and 1 responded with metronidazole.

Conclusions:

This case discusses a rare cause of chronic diarrhea in an effort to increase awareness of this disease process. Since most patients respond to immunosuppressants, recognition is the key to good outcomes

Author Disclosure:

M. Beachy, none.

To cite this abstract:

Beachy M. Diarrhea, Recurring Symptom Different Diagnosis. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 218. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/diarrhea-recurring-symptom-different-diagnosis/. Accessed September 17, 2019.

« Back to Hospital Medicine 2010, April 8-11, Washington, D.C.