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Case Reports
. 2024 Nov 3;16(11):e72939.
doi: 10.7759/cureus.72939. eCollection 2024 Nov.

Pediatric Collagenous Gastroduodenitis: A Rare Cause of Iron-Deficiency Anemia

Palack Agrawal  1 , Keshav Bhattar  2 , Claudia Rojas  3 , Jacqueline Larson  4
Affiliations
Case Reports

Pediatric Collagenous Gastroduodenitis: A Rare Cause of Iron-Deficiency Anemia

Palack Agrawal et al. Cureus. .

Abstract

Collagenous gastroenteritidesare rare disorders of unknown etiology diagnosed histologically by marked subepithelial deposition of collagen bands thicker than 10µm in the lamina propria with a mononuclear inflammatory infiltrate. Collagenous gastritis (CG) is divided into two phenotypes - pediatric-onset and adult-onset. Up until recently, pediatric-onset CG was thought to be confined to the stomach presenting with abdominal pain and anemia with limited involvement of the colon. Whereas adult-onset CG is often associated with involvement of the small and/or large intestine presenting with chronic non-bloody diarrhea and weight loss. It is now acknowledged that adult-onset and pediatric-onset CG should be considered a similar disease on a continuous spectrum. There are limited case reports of pediatric patients diagnosed as CG with concurrent collagenous duodenitis (CD) and/or collagenous colitis (CC). There are no accepted therapeutic standards for treating these patients. We present a rare case of an adolescent male with selective IgA deficiency and growth hormone deficiency presenting with severe iron deficiency anemia and abdominal pain with an ultimate diagnosis of collagenous gastroduodenitis with suspected jejunal involvement.

Keywords: anemia; collagenous duodenitis; collagenous gastritis; collagenous gastroenteritides; jejunum.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Esophagogastroduodenoscopy findings (A, B, C) and pill cam (D).
(A) Gastric body and (B) fundus: diffuse nodularity, erythema, and swelling. (C) Duodenal bulb: diffuse nodularity, swelling, erythema, fissured appearance, villous blunting, and few aphthous ulcers. (D) Proximal jejunum: erythema, swelling, and villous blunting.
Figure 2
Figure 2. Histopathological examination.
(A) Gastric antrum: 40 eosinophils/high-powered field (hpf) in the lamina propria and thickened subepithelial collagen layer (arrow), (B) gastric antrum: positive trichome stain for subepithelial collagen deposition (arrow), (C) duodenal bulb: 45 eosinophils/hpf in the lamina propria, thickened subepithelial collagen layer (arrow), and villous blunting (D) duodenal bulb: positive trichome stain for subepithelial collagen deposition (arrow).
Figure 3
Figure 3. Esophagogastroduodenoscopy findings after 8 weeks of budesonide 9 mg.
(A) Gastric body: diffuse nodularity, erythema, and swelling, (B) gastric body: narrow-band imaging (NBI) showing the mucosal surface of the nodular lesions without marked changes and abnormal capillary vessels. The depressed mucosa surrounding the nodules shows no changes and no abnormal capillary vessels. The depressed mucosa surrounding the nodular lesions shows an amorphous or absent surface structure and abnormal capillary vessels. (C) Duodenal bulb: diffuse nodularity, swelling, erythema, villous blunting, fissured appearance, and few aphthous, (D) Duodenal bulb: NBI showing the same findings as (B) gastric body.
Figure 4
Figure 4. Histopathological examination after 8 weeks of budesonide 9 mg.
(A) Gastric body: 30 eosinophils/hpf in the lamina propria, thickened subepithelial collagen layer (arrow), (B) gastric body: positive trichome stain for subepithelial collagen deposition (arrow), (C) duodenal bulb: 70 eosinophils/hpf in the lamina propria, villous blunting, and thickened subepithelial collagen layer (arrow), (D) duodenal bulb: positive trichome stain for subepithelial collagen layer (arrow).
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