Image of the Month
A 12-year-old asymptomatic girl on an unrestricted diet came to medical attention for pallor, with Hgb 4.8, Hct 17.3, and low serum iron. She denied nonsteroidal anti-inflammatory drug use, and long-distance running. Stools were intermittently positive for occult blood and negative for parasites. Serum albumin, celiac screen, anti-Saccharomyces cerevisiae antibodies, anti-neutrophil cytoplasmic antibodies, and erythrocyte sedimentation rate were normal. The anemia was corrected with oral iron supplementation. Endoscopy showed a striking nodularity of the gastric body with smooth peninsula-shaped areas, relative antral sparing, no erosions, and normal appearance of other areas of the upper and lower gastrointestinal tracts. Gastric biopsies showed moderate-to-marked chronic and eosinophilic inflammation, a collagenous band within the superficial lamina propria, with no Helicobacter or granulomas. Colonoscopic biopsies showed no collagenous band.
The patient remained asymptomatic, with normal growth, but requiring oral iron. She developed autoimmune hypothyroidism. Gastric parietal cell antibodies were negative. Gastrin and pepsinogen II levels were normal. There was no peripheral eosinophilia, and minimal if any response to an elimination diet.
Nodularity of the gastric body has been termed as chronic varioliform gastritis, which has not necessarily been associated with collagenous gastritis histologically. These are descriptive terms rather than specific diagnoses, and no single etiology or specific treatment has been established.
The authors report no conflicts of interest.
Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.