What Cause of Persistent Diarrhea and Weight Loss?
A 28-year-old woman presents with a 4-month history of diarrhea and a 15-lb weight loss. She reports starting “another new diet” a few months ago but was in good health until these symptoms began. There is no family history of GI disease and no sick contacts. She denies recent travel.
A 28-year-old woman presents with a 4-month history of diarrhea and a 15-lb weight loss. She was in her usual state of health until these symptoms started. She reports that she has always been “a little overweight” and has been trying to lose weight again.
The patient denies constitutional symptoms, such as fevers, chills, fatigue, and lethargy. She reports that diarrhea occurs 2 or 3 times daily and is not temporally related to eating. There is no mucus or blood in the stool. She experiences some mild cramps, but no significant abdominal pain. There is no family history of GI disease, and no one with whom she is associated has similar symptoms. She has not traveled recently, drinks only bottled or city tap water, and has not been camping.
The patient denies any rashes, joint pains, mouth ulcers, shortness of breath, and changes in her menses. She is 5 ft 3 in tall and weighs 145 lb. Her vital signs are normal.
She takes oral contraceptives, does not smoke or take illicit drugs, and does not drink to excess. She is married and has 1 child.
A stool sample is negative for occult blood. Screening laboratory findings: hemoglobin, 13.5 g/dL; WBC, 7400/µL, with a normal differential; platelet count, 215,000/µL; ESR, 12 mm/h; CRP, 1.5 mg/mL. All other chemistries are normal. Tests for laxative abuse (phenolphthalein) and a culture for Clostridium difficile are negative.
So far, there are not many facts on which to build a diagnosis-crampy abdominal pain, weight loss, and chronic diarrhea with no remarkable laboratory results.
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