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Crypt abscesses in the colon
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0/6
Graulomatous inflammation of the colon
Lymphocytic infiltration of the gastric mucosa
Mucosal flattening and blunting of villi
100%
6/6
Normal appearing intestinal mucosa
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This patient is suffering from celiac disease given her diarrhea, weight loss, dermatitis herpetiformis, and symptoms that improve with fasting. Mucosal flattening and blunting of villi with lymphocytic and plasma cell infiltration is expected on intestinal biopsy. Celiac disease is a chronic hereditary malabsorption disease caused by gluten intolerance. Gluten acts as an antigen and forms an immune complex in the intestinal mucosa, which promotes the aggregation of lymphocytes. These lymphocytes cause mucosal damage. Laboratory evaluation to suggest the diagnosis includes elevated anti-endomysial antibodies, elevated antigliadin antibodies, or elevated anti-tissue transglutaminase antibodies. The diagnosis is confirmed with intestinal biopsy which will show mucosal flattening and blunting of villi with lymphocytic and plasma cell infiltration. Figure A demonstrates dermatitis herpetiformis which presents with pruritic and papulovesicular lesions usually on the extensor surfaces, commonly on the elbows, knees, shoulders, and buttocks. Incorrect Answers: Answer 1: Crypt abscesses in the colon are found in ulcerative colitis which presents with fever, abdominal pain, arthralgias, erythema nodosum, and grossly bloody stool with ANCA positivity. Answer 2: Graulomatous inflammation of the colon could be seen in a patient with Crohn disease which presents with fever, abdominal pain, diarrhea, fecal occult positive stool, pyoderma gangrenosum, and malaise. This is an ASCA-positive disease on serology. Answer 3: Lymphocytic infiltration of the gastric mucosa is consistent with a diagnosis of gastritis which presents with chronic epigastric pain that can be described as burning or gnawing. Answer 5: Normal appearing intestinal mucosa would be seen in lactose intolerance which presents with bloating, flatulence, and watery diarrhea when the patient eats dairy. This patient has eliminated dairy with no improvement in her symptoms. Bullet Summary: The diagnosis of celiac disease can be confirmed with endoscopy and biopsy demonstrating mucosal flattening and blunting of villi.
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