Tufting enteropathy and skeletal dysplasia: is there a link?
BACKGROUND
Tufting enteropathy (intestinal epithelial dysplasia), a rare congenital enteropathy, presents in the first few months of life with chronic watery diarrhoea and impaired growth. The molecular basis for this condition is not known. We report our experience with a case of tufting enteropathy that developed an unusual skeletal dysplasia with an abnormal blood picture. After extensive investigations including repeated gastrointestinal endoscopies and biopsies, the diagnosis of tufting enteropathy was made. During the third year of her life, the patient's height was static. A full skeletal survey was performed and demonstrated features of generalised skeletal dysplasia, some of them consistent with those of parastremmatic dwarfism. At the age of five years, she developed Coomb's positive haemolytic anaemia and thrombocytopenia with a negative auto-antibody screen including anti-enterocyte antibodies.


CONCLUSIONS
There might be generalised matrix (including cartilage matrix protein), basement membrane abnormalities or both. A secondary protein leak might occur in the intestine with autosensitisation and development of autoimmune phenomena. More molecular research is needed to identify a possible link.
El-Matary
Wael
W
Gastroenterology Unit, Royal Liverpool Children's NHS Trust, Alder Hey, Eaton Road, Liverpool, L12 2AP, UK. welmatary@yahoo.com
Dalzell
A Mark
AM
Kokai
George
G
Davidson
Joyce E
JE
D001848:Bone Diseases, Developmental / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002675:Child, Preschool; D003968:Diarrhea, Infantile / Q000150:complications*; D004392:Dwarfism / Q000150:complications*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008286:Malabsorption Syndromes / Q000150:complications* / Q000503:physiopathology; D010289:Parenteral Nutrition, Total; D011859:Radiography