Topical sprue

• Facts:
  Chronic diarrheal illness characterized by malabsorption of nutrients, especially vitamin B 12 and folic acid, leading to megaloblastic anemia
  
  Involves the small intestines
  
  Patients have history of living in endemic areas
• History / PE:
  Chronic diarrhea, flatulence, fatigue
  Borborygmi
  Progressive weight loss
  Malabsorption symptoms (cheilosis, glossitis, pallor)
  
• Diagnosis:
  Blunting of villi with infiltration of chronic inflammatory cells, including lymphocytes, plasma cells, and eosinophils
• Differential Diagnosis:
  Celiac sprue (positive family history)
  Bacterial overgrowth
• Risk Factors:
  Recent travel to endemic areas