June 2017 - Presented by Dr. Pritesh Chaudhari (Mentored by Dr. 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


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Figure 1 Figure 2
Figure 3 Figure 4

Microscopic Findings

The gastric biopsy shows focal sub-epithelial collagen accumulation and associated inflammation, highlighted by special stain Trichrome.

What is the diagnosis?

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The correct answer is

C. Collagenous gastritis

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