Question of the Week # 443

443 ) A 38 year old man is evaluated in your office for a chronic rash on his elbows. He reports this has been worsening over the last 6 months and is intensely itchy. He lost about 8lbs weight in the past 6 months. Review of systems is normal except for 4 to 5 episodes of loose stools every day. Laboratory investigations reveal moderate microcytic anemia. On examination, he is afebrile. There is a vesicular rash on the extensor aspects of his bilateral elbows as shown below:

elbows

Which of the following is most helpful in diagnosing this condition?

A) Fecal occult blood testing and Sigmoidoscopy

B) Anti-nuclear antibodies

C) Anti-Endomysial antibodies

D) Small bowel follow through

E) Anti-Sacharomyces Cerviseae antibodies ( ASCA)

15 Responses

  1. C

  2. Answer: C
    Dx: Celiac Sprue dz
    Sx: herpetiform rash

  3. C.

  4. C

  5. Anti endomicial y anti tissue glutamic antibody y

  6. c- anti endomysial Ab…rash is dermetiformus herpeticum, due to celiac sprue

  7. C.
    Search for coeliac disease

  8. C,,,,COELIAC DISEASE

  9. Its Celiac D, anti Transglutimosidase ab.share any Q/concern…..
    neel,
    mbsnp12@gmail

  10. how to diff,w/ topical sprue?

  11. answer d??

    please let us know dr archer

    • Answer is C.
      the patient has clinical features suspicious for Celiac disease. Rash on the extensor surfaces resemble Dermatitis Herpetiformis which can be associated with celiac disease. Frequent diarrhea indicates a possible GI disorder and microcytic anemia from possible iron malabsoroption is additional clue for celiac disease. Putting these three clues together most likely etiology is Celiac disease and Anti-Endomysial antibodies are good screening tests for this disease.
      Small Bowel Follow Through are x-rays useful in detecting small bowel crohns, malignancy, obstruction etc

  12. Dermatitis herpetiformis. Classic celiac. Autoimmune disorders are on a significant rise in the usa. Wheat in usa has 50x the gluten than it did 50 yrs ago. Gf diet is recommended.

  13. C

  14. ASCA tests for what?

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