Diagnostic Dilemma

A 4½ years old boy with recurrent persistent diarrhea

A 4½ year old boy presented with recurrent diarrhea. He had first episode of persistent diarrhea at 3½ years of age associated with weight loss and was diagnosed to have TB and was given antituberculous therapy for 6 months. At that time, he had hypokalemia and hypoalbuminemia. His HIV ELISA was negative. He had repeat episode of diarrhea at 4 years of age associated with cheilitis, dermatitis, edema and weight loss. His Mantoux test was positive. His stool examination was normal and stool for cryptosporidium was negative.
Again he showed an improvement and he regained 3 kg of weight. Presently, the child had loss of weight since 1 month and watery, oily stools since last 5 days. On examination, he was malnourished {Weight = 10 kg, Height = 97 cm} with pallor and had signs of dehydration. Systemic examination was normal. He was treated with intravenous fluids, potassium supplements. He also developed carpopedal spasm and was treated with IV calcium. His stool examination showed presence of yeast cells and his Albumin was low {2.2 gm percent}. His hemoglobin was 9.2 gm, dl, WBC count = 71,900, cumm {79 percent polymorphs, 18 percent lymphocytes and 3 percent monocytes} with thrombocytosis. Serum calcium was 8.4 mg percent and phosphorus was 2.3 mg percent with normal alkaline phosphatase. His antigliadin antibodies IgA and IgG were positive. He has been posted for colonoscopy

What other diagnosis apart from Coeliac disease should be ruled out_?
Expert Opinion :
His colonoscopy was suggestive of chronic villous atrophy. His sweat chlorides were normal. We started him on gluten free diet and the child is doing well currently.
Answer Discussion :
malabsorption syndrome
9 years ago
Mohan raja
ileocecal tuberculosis
9 years ago

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