MTC: Silent Celiac Disease

Rebecca Kim, PGY4 presented a great case this morning of a previously healthy 54 year old gentleman presenting with 2-3 weeks of post-prandial nausea/vomiting and abdominal distention, with 3-4 days of absence of bowel movements and flatus. Patient found to have small bowel obstruction due to a duodenal mass. Pathology showed duodenal adenocarcinoma with negative margins and negative lymph nodes, and interestingly, patient found to have underlying histologic changes suggestive of celiac disease – flattened, atrophic villi and increased intraepithelial lymphocytes. Patient denied any history of symptoms consistent with celiac disease, and therefore was diagnosed with silent celiac. Notably, his labs did show microcytic anemia, suggestive of chronic malabsorption secondary to celiac, and serologies (anti-TTG IgA, anti-DGPs) were elevated, as well. We then reviewed the presentation, pathophysiology, diagnosis, and management of celiac disease. We also learned about potential complications of celiac disease including anemia, osteoporosis, etc., and the increased risk of small bowel lymphoma and adenocarcinoma. At UCSD, we are

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MTC: Kikuchi Disease (Histiocytic Necrotizing Lymphadenitis)

Dr. Aaron Kofman, one of our graduating R3s, presented an exciting case today at Hillcrest morning teaching conference. 33yo F with history of vitiligo and fibromyalgia presenting with 5 weeks of fevers. The patient reported weight loss, night sweats, chills, fatigue, chest discomfort and associated shortness of breath. She had been treated at an outside hospital for “pneumonia” and had a few additional outpatient visits that were unable to determine an etiology for her fevers. We discussed whether this was considered to be fever of unknown origin (FUO) and what the best approach to this problem is. Fever of Unknown Origin is defined as follows: Fever > 38.3 C or 100.9 F Occurring for > 3 weeks Etiology unclear after 3 outpatient visits or 3-7 days of hospitalization The stepwise evaluation of FUO should proceed as follows: A thorough history & physical (with special focus on travel, immunosuppression, sick contacts, ingestions, etc) An initial survey comprising of CBC w/ diff,

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