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Gastroenterology (Expert Forum)
Pediatric GI problems with chronic fever
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Pediatric GI problems with chronic fever
by JStasinos, Jun 23, 2009 08:04AM
I have a 4.5 year old daughter who has been complaining of abdominal pain since September. Associated symptoms of intermittent diarrhea, poor color, weight loss, and chronic low-grade fever. It is cyclical started with extreme tiredness, color changes from normal to very pale, onset of fever, then onset of abdominal pain. We have been tracking it to about every 2-3 weeks.
Initial GI labs all normal (taken in Dec), allergy testing for whey, egg, milk, wheat-negative, AST-31, ALT 15, tTG AB, IGA 0.4, Giliadin IGA 1.9, Giliadin, IGG 4.7, IGA, 167, CRP, 0.5
Ultrasound of abdominal, pancreas, etc normal
Hospital stay of 5 days in MArch, due to dehydration from Rota virus, admitted for IV fluids, was supposed to remain just overnight, remained longer for observation.
Colonoscopy & endoscopy performed May 20. Initial results appeared all normal. Biopsy results revealed lactase deficiency, (which GI does not think is accurate as she does not fit the "profile, no sure what to make of that), biopsy of the esophagus showed mild irritation, small intestine show mild, non specific inflammation. Presence of monocytes (GI states normal in young children) -having follow up 7/10
Another hospital stay 5/26/09 for observation due to pain, lethargy, fever...abnormal labs- show
CRP 22.2,
RDW- % neut 68, % lymph 26
ESR 21
white count 10.2
CT scan of abdomen-normal
Upon recommendation of pediatrician, saw immunologist who ran addl labs (pending), but also wanted referral to rheumotologist and return visit to GI as he interpreted some of the GI biopsies as abnormal.
We have been trying to get a handle on this problem, but no one doctor seems to be able to grasp what is going on. Symptoms or frequency is not improving. Any suggestions?
Initial GI labs all normal (taken in Dec), allergy testing for whey, egg, milk, wheat-negative, AST-31, ALT 15, tTG AB, IGA 0.4, Giliadin IGA 1.9, Giliadin, IGG 4.7, IGA, 167, CRP, 0.5
Ultrasound of abdominal, pancreas, etc normal
Hospital stay of 5 days in MArch, due to dehydration from Rota virus, admitted for IV fluids, was supposed to remain just overnight, remained longer for observation.
Colonoscopy & endoscopy performed May 20. Initial results appeared all normal. Biopsy results revealed lactase deficiency, (which GI does not think is accurate as she does not fit the "profile, no sure what to make of that), biopsy of the esophagus showed mild irritation, small intestine show mild, non specific inflammation. Presence of monocytes (GI states normal in young children) -having follow up 7/10
Another hospital stay 5/26/09 for observation due to pain, lethargy, fever...abnormal labs- show
CRP 22.2,
RDW- % neut 68, % lymph 26
ESR 21
white count 10.2
CT scan of abdomen-normal
Upon recommendation of pediatrician, saw immunologist who ran addl labs (pending), but also wanted referral to rheumotologist and return visit to GI as he interpreted some of the GI biopsies as abnormal.
We have been trying to get a handle on this problem, but no one doctor seems to be able to grasp what is going on. Symptoms or frequency is not improving. Any suggestions?
Doctor's Answer
by Kevin Pho, MD, Jun 24, 2009 06:50AM
, Jun 24, 2009 06:50AM
I agree with the workup thus far, and it has been comprehensive. If there is GI cause of the fever and pain, the combination of scans and endoscopies that were perform would likely have found it.
One thing I would test for would be celiac disease, as well as other forms of malabsorption. But if the GI tests continue to be negative, you may want to consider looking elsewhere.
With a chronic fever, that could be indicative of an infection. An elevated CRP, which is a marker of inflammation, may be consistent with this.
Discussing whether an infectious disease specialist would be helpful can be done with your daughter's pediatrician.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin Pho, M.D.
KevinMD.com
Twitter.com/kevinmd
One thing I would test for would be celiac disease, as well as other forms of malabsorption. But if the GI tests continue to be negative, you may want to consider looking elsewhere.
With a chronic fever, that could be indicative of an infection. An elevated CRP, which is a marker of inflammation, may be consistent with this.
Discussing whether an infectious disease specialist would be helpful can be done with your daughter's pediatrician.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin Pho, M.D.
KevinMD.com
Twitter.com/kevinmd
