CHRONIC DIARRHEA AFTER A TRAVEL TO SOUTH-EAST ASIA - A CASE OF TROPICAL-SPRUE

A 43-year-old woman developed abdominal pain and diarrhea following a travel to Malaysia. Examinations in another hospital proved no evidenc e of infection, an empirical antibiotic therapy with ciprofloxacin yie lded no benefit. One and a half year later, the patient was admitted t o our department because of persistent diarrhea and waisting. Laborato ry tests showed megaloblastic anemia, folate deficiency and steatorrhe a. Stool specimens for bacterial pathogens and parasites were negative . Endoscopy and biopsy from the distal portion of the duodenum reveale d broadening and shortening of the villi and an increased infiltration of the lamina propria by chronic inflammatory cells (plasma cells and lymphocytes). In conclusion, diagnosis of tropical sprue was establis hed. The therapy comprised of tetracycline for six weeks and folic aci d for six months. Subsequently, the diarrhea disappeared, the patient continuously gained weight and was free of any com plaints. The comple te remission following this regimen proved the suspected diagnosis. Di fferential diagnosis in any patient who recently returned from the tro pics may be a challenge. Tropical sprue predominantly occurs during or after a longer stay in endemic areas. However, if chronic diarrhea an d signs of malabsorption develop after a short journey to India, South -East Asia and parts of the Caribbean, tropical sprue has to be consid ered, too.