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An unexpected target
  1. Matthew Smith1,
  2. Christopher Allen2,
  3. Nicholas Hudson1
  1. 1Department of Gastroenterology, Worcestershire Royal Hospital, Worcester, UK
  2. 2Department of Pathology, Worcestershire Royal Hospital, Worcester, UK
  1. Correspondence to Matthew Smith, Worcestershire Royal Hospital, Department of Gastroenterology, Aconbury East, Charles Hastings Way, Worcester WR5 1DD, UK; dr_matt_smith{at}

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Clinical presentation

A 56-year-old man was referred to the gastrointestinal clinic with 13 kg weight loss over 3 months associated with intermittent, poorly localised abdominal pain and a 1 week history of self-limiting diarrhoea. There was no significant past medical or family history. He was a non-smoker and vegetarian. Physical examination was unremarkable. Laboratory tests revealed a thrombocytosis (577×109/l) and folate deficiency (1.6 ng/ml); haemoglobin, white cell count, inflammatory markers and biochemical indices (renal, liver and thyroid function) were normal. Immunological tests revealed a strongly positive tissue transglutaminase (TTG) and positive antiendomysial antibodies. He underwent urgent CT …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.