Case of the Month August 2021

A 19-year-old woman presented to her gastroenterologist with a chief complaint of chronic abdominal pain. Her past medical history included allergic rhinitis, anxiety, gastroesophageal reflux disease, iron deficiency anemia, migraines, and an eating disorder. Her medications included amitriptyline, gabapentin, acetaminophen, esomeprazole magnesium, ferrous sulfate, fluticasone propionate nasal spray, hyoscyamine, melatonin, and omeprazole. Laboratory tests for tissue transglutaminase IgA and deaminated gliadin were negative. Serum IgA levels were normal. She underwent esophagogastroduodenoscopy which showed a normal-appearing esophagus, bilious-appearing fluid in the stomach, moderate erythema of the gastric antrum and body with significant nodularity of the gastric body, and a normal appearing duodenum. Biopsies were obtained of the esophagus, gastric antrum and body, and duodenum. The biopsies of the esophagus, antrum, and duodenum were normal. Endoscopic photos of the gastric body and photomicrographs of the H&E-stained slides of the gastric body are seen below. Immunohistochemical stains for gastrin and H. pylori and Congo red stain for amyloid on the biopsies of the gastric body were negative. Prior biopsies of her colon were normal.


GIPS_COM_August 2021

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