Arab Journal of Gastroenterology xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Case Report
An elderly lady with significant weight loss Bandar Al-Judaibi a,b,c,⇑, David K. Driman b,c, Natasha Chandok a,c a
Department of Medicine, Division of Gastroenterology, London Health Science Center, The University of Western Ontario London, Ontario, Canada Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia c Department of Pathology, London Health Science Center, The University of Western Ontario London, Ontario, Canada b
a r t i c l e
i n f o
Article history: Received 6 April 2013 Accepted 22 October 2014 Available online xxxx Keywords: Collagenous sprue Coeliac disease Collagen band
a b s t r a c t We present a rare case of collagenous sprue in an elderly woman with significant weight loss and malnutrition. Collagenous sprue is a rare, female-predominant and immune-mediated gastrointestinal disease that can affect any part of the gut, and shares a strong association with Coeliac disease. The diagnosis is confirmed by gut histopathology demonstrating a subepithelial collagenous band and inflammatory infiltrate in the lamina propria. The pathogenesis and natural history is poorly elucidated, and treatment involves a gluten-free diet and/or immunomodulatory therapy. Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
Case A 68 year old Caucasian woman presented with a 20% unintended weight loss over 1 year. She denied having any nausea, vomiting, diarrhoea, abdominal pain, gastrointestinal haemorrhage or fevers, and she claimed that her appetite was preserved. Her past-medical history included hypothyroidism and chronic obstructive pulmonary disease (COPD), and she is maintained on levothyroxine and combivent. On examination, she appeared severely malnourished, and had body mass index of just 15.6 kg/m2. Her investigations revealed haemoglobin of 102 g/L (normal 115–160), mean corpuscular volume (MCV) 100.8 (normal 79-97), leucocyte 3.9 109 cells/mL (normal 4.0-10), platelet 298 109/mL (normal 150–400), international normalised ratio (INR) 0.9 (normal 0.9–1.1) and albumin 30 g/L (normal 35–52). Her tissue transglutaminase antibody was elevated at 42 units (normal
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Case Report
An elderly lady with significant weight loss Bandar Al-Judaibi a,b,c,⇑, David K. Driman b,c, Natasha Chandok a,c a
Department of Medicine, Division of Gastroenterology, London Health Science Center, The University of Western Ontario London, Ontario, Canada Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia c Department of Pathology, London Health Science Center, The University of Western Ontario London, Ontario, Canada b
a r t i c l e
i n f o
Article history: Received 6 April 2013 Accepted 22 October 2014 Available online xxxx Keywords: Collagenous sprue Coeliac disease Collagen band
a b s t r a c t We present a rare case of collagenous sprue in an elderly woman with significant weight loss and malnutrition. Collagenous sprue is a rare, female-predominant and immune-mediated gastrointestinal disease that can affect any part of the gut, and shares a strong association with Coeliac disease. The diagnosis is confirmed by gut histopathology demonstrating a subepithelial collagenous band and inflammatory infiltrate in the lamina propria. The pathogenesis and natural history is poorly elucidated, and treatment involves a gluten-free diet and/or immunomodulatory therapy. Ó 2014 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
Case A 68 year old Caucasian woman presented with a 20% unintended weight loss over 1 year. She denied having any nausea, vomiting, diarrhoea, abdominal pain, gastrointestinal haemorrhage or fevers, and she claimed that her appetite was preserved. Her past-medical history included hypothyroidism and chronic obstructive pulmonary disease (COPD), and she is maintained on levothyroxine and combivent. On examination, she appeared severely malnourished, and had body mass index of just 15.6 kg/m2. Her investigations revealed haemoglobin of 102 g/L (normal 115–160), mean corpuscular volume (MCV) 100.8 (normal 79-97), leucocyte 3.9 109 cells/mL (normal 4.0-10), platelet 298 109/mL (normal 150–400), international normalised ratio (INR) 0.9 (normal 0.9–1.1) and albumin 30 g/L (normal 35–52). Her tissue transglutaminase antibody was elevated at 42 units (normal
