PMC8022033_01
PMC8022033_02
Growth curve of the patient. The closed triangles indicate the onset of clinical
symptoms. The horizontal bar shows the start of the treatment using a gluten-free
diet.
cpe-30-105-g001.jpg
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fig_001
He had been failing to thrive from five months of age, as shown by his growth chart (Fig. 1).
PMC8022033_03
X-ray image of the left hand at admission (8 mo of age). The image shows cupping and
fraying of the metaphysis.
cpe-30-105-g002.jpg
PMC8022033_03_cpe-30-105-g002.jpg
fig_002
Wrist X-ray showed cupping of the distal radius and flaring of the distal ulna, indicating severe rickets (Fig. 2).
Clinical course of the patient. The primary and follow-up treatments and their key
laboratory findings are serially described.
cpe-30-105-g003.jpg
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fig_003
Intravenous supplementation of calcium gluconate followed by alpha calcidol, calcium lactate tocopherol acetic acid, and menatetrenone were started, but his chronic diarrhea with muddy stools continued over several days (Fig. 3).
PMC8022033_04
Histopathological findings of the duodenal biopsies (H&E staining). The patient's
condition was categorized as type 3c based on the modified Marsh classification. a
(100 x): Flat mucosa with complete loss of the normal villous architecture. b (400 x):
Increased intraepithelial lymphocyte infiltration.
cpe-30-105-g004.jpg
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fig_004
Non-specific findings of chronic inflammation in the small intestine and villous atrophy were noted (Fig. 4) and several antigen-specific IgEs were detected, with positive results from class 0 to class 3, although the symptoms of the patient were not suggestive of rapid onset WA.