2015-05-26 19:07:04 UTC

9-Year-Old Girl With Poor Weight Gain and Postprandial Vomiting

May 26, 2015

The May 2015 Gastro image challenge examines a young patient with epigastric pain and anorexia.

Question: A 9-year-old girl presented with epigastric pain, postprandial vomiting, anorexia and poor weight gain for six months. On examination, she was less than the fifth percentile for height, weight and body mass index. An EGD report from three months before arrival to the hospital revealed erythematous gastric mucosa with ulcerations and edema of the pyloric canal. She was treated for Helicobacter pylori and cytomegalovirus (CMV) without improvement.

Laboratory results showed the following: White blood cell count 4.4 × 109/L (27.3 percent neutrophils, 64 percent lymphocytes, 6.6 percent monocytes, 1.4 percent eosinophils, 0.7 percent basophils), hemoglobin 9.5 g/dL, mean corpuscular volume 82 fL, red cell distribution width 24.2 percent, platelet count 556 × 109/L, total protein 4.7 g/dL and albumin 2.5 g/dL. Review of records showed negative anti-neutrophil cytoplasmic antibodies, anti-Saccharomyces cerevisiae antibodies (ASCA) and tissue transglutaminase immunoglobulin (Ig)G and IgA. Serum total IgA levels were normal.

Upper Gl series showed thickened gastric folds and narrowing of the pyloric canal (Figure A). Repeat EGD showed erythematous and friable mucosa, superficial ulcerations, and nodularity (Figure B–E). Friability, ulceration and scarring of the prepyloric area and pylorus were appreciated; therefore, the duodenum was not able to be visualized. Colonoscopy was unremarkable. Histologic sections of the gastric biopsy specimens are shown in Figures F–I.

What is the diagnosis? To find out, and to see the images in more detail, read the article in Gastroenterology.

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