Redon TA, Téllez GR, Guajardo CM, Rivera SR, Pichardo BR, Albarrán OR, Duarte SC, González SN

Language: Spanish
References: 13
Page: 79-85
PDF size: 234.75 Kb.

ABSTRACT

The case of a boy aged 9 months who was admitted by an unusual presentation of knee arthritis and monocytic malabsorption syndrome which carried him into a persistent severe malnutrition and into death is reported. Body weight at 9 months was 4,000 grams. A left knee big swelling was misdiagnosed as sceptic arthritis and so operated on, with postoperative negative cultures, persistent joint swelling and poor response to antibiotics. After repeating flare-ups of olygoarticular minor onsets and non-granulomatous uveitis, an autoimmune process was suspected. Monocytic malabsorption diagnosis was established after endoscopic biopsy, as a result of presence of inflammatory monocyte infiltration over the lamina propia at the jejunal mucosa. Positive HLA-B27 antigen as well as increased IL-6, C-reactive protein up to 65.8 mg/dL and sedimentation rate of 53 mm, were all non-conclusive supportive features for autoimmunity. Patient never gained body weight in spite of different unsuccessful efforts to nourish him. His prevalent general poor health condition was misinterpreted by his relatives as something normal for that baby, as the aberrant parental rationale was to refuse a late attempt to furnish feeding into a specialized non-cost nutritional facility (White Cross Hospital). Diagnosis of desvinculation disorder of parental-child bonding was so established. After relieving from pneumonia, patient died at age of 1 year and 11 months at another local facility, as a result of massive gastro-esophagic bleeding, consecutive to the insertion of a nasograstric tube intended to relief abdominal distention. Bleeding is described since infiltrated mucous membrane of gut is highly sensitive even to minor trauma.

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