2002/03/01 by Gisella Salerno, Jonathan Gilbert, Haytham Sharif · 1 citation
Medicine · #Alternative medicine #Bone and Joint Diseases #Bone health and treatments #Computer science #General surgery #Hyperparathyroidism #Knee pain #Medicine #Osteoarthritis #Parathyroid Disorders and Treatments #Pathology #Surgery #World Wide Web
paper · pdf · doi:10.1177/014107680209500308
openalex publication_date 2002/03/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/06/26
disease, and again a dietitian conrmed adherence to a strict gluten-free diet.Her haemoglobin was 12.6 g/dL, mean corpuscular volume 82 fL, albumin 33 g/L (normal 3550), antiendomysial antibody positive, vitamin B12 normal and red cell folate low at 145 ng/mL (normal 4185).A barium follow-through showed a rather featureless jejunal mucosa but no obstructive lesion of the small bowel; nothing abnormal was seen on an ultrasound scan of the abdomen.In view of her worsening symptoms despite a gluten-free diet, she was started on prednisolone, initially 30 mg daily, and over the next year her clinical condition improved, with resolution of her diarrhoea and a weight gain of 5 kg.At the time of discontinuation of prednisolone a year later she developed involuntary writhing movements of her left limbs.On examination she had choreo-athetoid movements involving the left limbs and persistent dysarthria.There was no associated weakness and sensation was normal.At that time she was taking digoxin, aspirin, ferrous sulphate and thyroxine; she had never received any neuroleptic medication.Magnetic resonance scanning of the brain and brainstem was normal, with no evidence of an infarct and no lesion in the basal ganglia.Genetic testing for Huntington's diseasea search for the hallmark abnormal CAG repeats on chromosome 4was negative.No underlying neurological disease to explain her chorea was found.Her chorea continued and seven months later she developed acute abdominal pain.At emergency laparotomy she was found to have a perforated jejunal tumour, which was resected.It proved to be a non-Hodgkin's T-cell lymphoma.She subsequently had intravenous chemotherapy with doxorubicin, cyclophosphamide and vincristine, but deteriorated three months postoperatively and died.