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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 …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.