Residency Program - Case of the Month
June 2017 - Presented by Pritesh Chaudhari (Mentored by Tao Wang)
Clinical History
Patient is 10-year-old female with profound iron deficiency anemia. Labs show hemoglobin of 3.6 g/dL, mean corpuscular volume of 54, serum iron of less than 5 ng/dL, serum ferritin of 1 ng/dL, and thrombocytosis with platelet count of 840/uL. Celiac serology was negative. This patient had vomiting 2 weeks prior after eating at a local restaurant; however no fever or diarrhea was reported. Currently, fecal occult blood test is positive. Patient has occasional abdominal pain. Stools are typically daily, soft, and not painful although yesterday's stool was harder than usual. Mother states that the patient eats lots of meat, drinks almond milk and otherwise eats a varied diet.
Endoscopic Findings
Mouth: Normal
Esophagus: Normal
Stomach: Nodular gastritis in body but relative sparing of prepyloric area.
Duodenum: Normal
Colonoscopic Findings:
Perianal area: Normal
Colon: Normal
Terminal Ileum: Normal
Histology
Click on image to enlarge.
Microscopic Findings
The gastric biopsy shows focal sub-epithelial collagen accumulation and associated inflammation, highlighted by special stain Trichrome.
Figure 1
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Figure 4
What is the diagnosis?
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