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Mary met her husband in a Chinese restaurant where she was a frequent patron. She had felt attracted to rice meals since a long time ago. She did not want to eat at home or in any European restaurant complaining that the food made her uncomfortable. She was very happy to move to Brunei with her husband. She adapted very well to local diets and she was in good health. Over the years she noted a pattern that whenever she accepted an invitation to the British Embassy she became ill passing foul smelling feces. On each occasion she went to the hospital and got a diagnosis of either indigestion or food poisoning. She slowly learned to attend social gatherings at the embassy. She sent her daughter to a British kindergarten in the town. The daughter started having frequent episodes of diarrhea during the week with a respite during the long weekend and holidays. Mary visited several physicians but none could explain the condition. The latest attack of diarrhea was so severe that the daughter had to be hospitalized for 2 weeks. Despite all investigations no diagnosis could be made. However anthropometric measurements showed that the daughter had retarded growth for her age and suffered from various vitamin deficiencies. On discharge Mary decided to take her daughter to London for specialist care. She told her story to a retired British pediatrician who sat next to her in the plane while returning from a holiday in Brunei. He immediately made a diagnosis and advised Mary to see a specialist at the Hospital for Sick Children in London.
At the hospital for sick children in London several investigations were carried out. Barium x-ray of the intestines revealed no anomaly. Under light anesthesia an endiscope was used to biopsy the small and large intestines. Histopathological examination showed atrophy of the villi. Laboratory examination of the serum revealed presence of antigliadin and anti-endomyosial IgA and IgG antibodies. Hematological examination showed features of mild anemia. There was reduction of albumin, vitamin, calcium and magnesium levels. A definitive diagnosis was made and dietary treatment was started with improvement seen within a few months.
Discussion issues
1. Discuss medical negligence regarding failure to suspect an uncommon disease