altered bowel habits, abd swelling occasional melena. progessively worsening.
Age/Sex/Height/Weight: 34 years / Male / 172.72 cm / 73 kg
Presenting Complaints (Chronic since 2020)
- Persistent right abdominal pain with two distinct tender sites on right abdomen:
- Upper marking: persistently swollen (non-tender)
- Lower marking: site of previous acute erosion (2020) followed by melena; still painful with movement or passage of contents
- New swelling marked on recent photo (since ~5 days)
- Altered bowel habit: loose + bulky/fatty stools with mucus
- Occasional melena
- Significant weight loss
- Hair fall with brittle nails (improves only with milk powder supplementation)
- Bloating, post-prandial discomfort, fatigue
Key Investigation Summary (Arranged Latest to Oldest)
Hematology:
- CBC (Dec 17, 2024): Hb 14.2 g/dL (mild anemia / low-normal), persistent lymphocytosis (45–52%), Total WBC & Platelets normal
- hs-CRP & Creatinine (24 Oct 2024): hs-CRP 1.3 mg/L (Normal), Creatinine 0.98 mg/dL (Normal)
- Ferritin (24 Oct 2024): Elevated 735 ng/mL
- Mantoux Test (2025): Normal
- LDH (03 Jul 2024): 170 u/L (Normal)
- Beta-2 Microglobulin (B2M) (2024): Normal
- Reticulocyte panel (03 Jul 2024): Normal
- CBCs (2023–mid 2024): Hb 13.1–14.2 g/dL, persistent lymphocytosis, ESR 10 mm/hr (normal)
Biochemistry & Immunology:
- Ferritin (Jul 2024): Elevated 766.6 ng/mL
- ANA (10 Jul 2024): Moderately positive, coarse speckled pattern
- Lipid Profile (27 May 2024): Dyslipidemia (Total Cholesterol 222, LDL 152, TG 170, HDL 36 mg/dL)
- Zinc (29 May 2024): Low (47.6 μg/dL)
- Ferritin (May 2024): Elevated 662.6 ng/mL
- tTG-IgA (16 Nov 2023): Normal
- HBsAg & Anti-HCV (06 Jun 2023): Negative
Stool Studies (2023–Mar 2025):
- Stool r/M & Occult Blood (Mar 2025): Mucus (++), occult blood positive, mild pus cells & RBCs
- Multiple prior stool tests: Recurrent mucus, negative for parasites, H. pylori antigen, bacterial pathogens
Imaging & Procedures:
- Colonoscopy (25 Mar 2025): Normal (up to terminal ileum)
- MR Enterography (17–20 Nov 2024): Normal
- Chest X-ray (24 Oct 2024): Normal
- Upper GI Endoscopy (15 May 2024): Mild gastritis
- USG Abdomen (27 May 2024): Normal
- MRCP (2023): Normal
Impression:
34-year-old male with chronic right abdominal pain, altered bowel habit, occasional melena, weight loss, mild anemia, persistent lymphocytosis, hyperferritinemia, positive ANA negative ENA profile, low zinc, and dyslipidemia. Mild gastritis on endoscopy. Negative extensive workup for infection, celiac disease, and biliary pathology.
u/Any-Wolverine9582 — 3 days ago
