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Refractory Sprue: Recovery After Removal of Nongluten Dietary Proteins

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▸Requests for reprints should be addressed to Alfred L. Baker, M.D.; Department of Medicine, Box 400, 950 East 59th Street; Chicago, IL 60637

Chicago, Illinois

© 1978 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1978;89(4):505-508. doi:10.7326/0003-4819-89-4-505
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A 44-year-old woman with diarrhea, weight loss, and a small-bowel biopsy consistent with adult celiac disease failed to improve on a gluten-free diet. Despite in-hospital supervision at two university medical centers and addition of corticosteroid therapy, diarrhea and weight loss continued, resulting in life-threatening nutritional depletion. She was transferred to the University of Chicago and made full nutritional recovery with total parenteral nutrition. Exploratory laparotomy showed no abnormality except the flat intestinal mucosal lesion. Diarrhea recurred when a gluten-free diet was resumed. When the patient ate egg, chicken, or tuna alone, severe diarrhea, hypotension, cyanosis, and shock occurred. When these foods—along with gluten—were eliminated from the diet, the patient returned to oral nutrition and made a full clinical recovery. In patients with refractory sprue deletion of other dietary proteins in addition to gluten, as in the present patient, may be lifesaving.





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