GI snapshot: weight loss and altered bowel habit in a 72-year-old woman

Introduction A 72-year-old woman presented with a 9-month history of alternating constipation and diarrhoea, with postprandial abdominal pain. She noted constitutional symptoms of weight loss, decreased appetite and night sweats. This occurred on a background of systemic lupus erythematosus (SLE), treated with 200 mg twice daily hydroxychloroquine and 10 mg daily prednisolone. She appeared cachectic with significant muscle wasting. Abdominal examination revealed diffuse tenderness on deep palpation, with no appreciable mass or lymphadenopathy. White cell count was 12.6x109/L (ref range: 4.0–11.0), platelet 580x109/L (ref range: 150–400), C reactive protein 149 mg/L (ref range: <5), erythrocyte sedimentation rate 91 mm/hour (ref range: <20). Tumour markers were within normal range. Rheumatological screening revealed an antinuclear antibody titre of 1:160, while dsDNA (ELISA) (59 IU/mL, ref range: <100) and other markers were negative. CT scan of the abdomen and pelvis revealed no malignancy. Prednisolone dose was weaned, given concern around muscle wasting. However, when weaned...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot, Gut Editor ' s quiz: GI snapshot Source Type: research