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December 1997

Pathological Case of the Month

Author Affiliations

From the Departments of Pediatrics (Dr Sidler) and Pathology and Laboratory Medicine (Drs Huston and Thomas), University of North Carolina, Chapel Hill.

Arch Pediatr Adolesc Med. 1997;151(12):1265-1266. doi:10.1001/archpedi.1997.02170490091019

A 10-MONTH-OLD white girl was referred to the University of North Carolina Hospitals for failure to thrive, chronic diarrhea, and a slightly protuberant abdomen. After 3 months of breastfeeding, a commercially available formula (Similac, Ross Products Division, Abbott Laboratories, Columbus, Ohio) was introduced, which resulted in episodes of emesis and large loose stools. At 5 months poor growth had become evident with weight less than the fifth percentile; height in the 25th percentile; and head circumference less than the fifth percentile. At 7 months of age, the patient's diarrhea was severe with voluminous watery green stools devoid of mucus or blood. Her weight continued to decline. A gluten-free diet failed to result in improvement of her condition. Motor development was delayed. Family history was unremarkable.

Peripheral blood smear showed acanthocytes (Figure 1), with a hemoglobin level of 120 g/L and a hematocrit of 0.36. Prothrombin time, partial thromboplastin time,