CHRONIC GIARDIASIS WITH INTESTINAL GROWTH FAILURE AND PUBERTAL DELAY IN DYSGAMMAGLOBULINEMIA

A 10-years-old, previously healthy Swiss boy suffered from repeated ep isodes of watery diarrhea for some months following a summer camp holi day. No etiology was found, and except for symptomatic treatment no ot her therapy was necessary. Five years later he was investigated becaus e of growth failure, with a bone age of 11.5 years, but the correct di agnosis was not established. Only when he was reinvestigated at the ag e of 20 years, because of persistent growth failure and a bone age of 14 years, were Giardia lamblia trophozoites seen microscopically on th e surface of duodenal mucosa biopsy specimens. At the same time dysgam maglobulinemia was detected which may have predisposed the gastrointes tinal tract to chronic giardiasis. After a 10-day course of metronidaz ole the patient experienced catch-up growth and completed his pubertal development. The dysgammaglobulinemia persisted after therapy. This c ase shows that in patients with intestinal growth failure, catch-up gr owth and completion of pubertal development are possible even after th e age of 20 years if nutritional supply is sufficient. Bone age determ inations serve to indicate remaining growth potential.