Chronic diarrhea with fever

Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital. Incharge, Pediatric HIV, TB and Liver Clinics, B.J.Wadia Hospital for Children.

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056.

Clinical Problem:
A 1 years old boy born of non-consanguineous marriage presented with recurrent watery, foul smelling diarrhea and fever for 2 months. He was treated with antibiotics, steroids and lactose free milk. His birth was normal and he was immunized till date. He was on exclusive breast feeds till 10 months of age and subsequently was started on weaning food. On examination, he had BCG Scar. He was malnourished {weight = 6.5 kg, Less than 5th centile} and had perianal excoriation. Systemic examination was normal. Investigations showed normal hemogram with normal liver function and renal function tests. His serum albumin was 4.6 mg, dl and venous blood gases were normal. Stool showed presence of mucus with fat globules. Stool for trypsin was positive. Sweat chlorides were normal. He was treated with oral antibiotics and metronidazole to which diarrhea responded. Serum immunoglobulins showed IgM 2.29 mg, dl {Normal = 41-173}, IgG = 667 mg, dl {Normal = 172-1069}, IgA = 70.97 mg, dl {Normal = 11 to 106}.

What is the diagnosis_? How to treat this patient_?