Case 2: Weight loss despite tube feeding

Extract

A 15-year-old boy was referred by his family physician for a body mass index of 14 kg/m². Previously, he had been following the fifth percentile for weight, despite being at the 50th percentile for height. His medical history was notable for eczema, iron-deficiency anemia and bronchitis. He unintentionally lost 4.5 kg over the past year, coinciding with the beginning of high school. He denied abdominal pain, vomiting, headaches, wheezing, reflux, arthritis, rashes and travels, and he passed formed stools daily. He was hungry, ate a varied diet, and denied concerns with body shape, restricting, binging or purging. Although he wished to gain weight, early satiety limited portion sizes. He was not physically active, but had healthy social and academic interests, and an appropriate mood. His mother had depression, two paternal uncles had celiac disease and his father reportedly had a transient malabsorptive problem as a child.

Physical examination was normal aside from obviously low weight. Complete blood count, electrolytes, transaminases, total protein, albumin, thyroid function, antinuclear antibody, rheumatoid factor, ferritin, C-reactive protein, urinalysis, celiac and HIV screens were unremarkable. Esophagogastroduodenoscopy showed mild chronic gastritis without Helicobacter pylori infection.