A 36-year-old man who moved to Kolkata two years ago develops chronic steatorrhea, bloating, and fatigue. Hemogram shows macrocytic anemia. Jejunal biopsy shows partial villous atrophy without the intraepithelial lymphocytosis of coeliac disease, and anti-tTG antibodies are negative. Which treatment is most appropriate?
- A Tetracycline with folic acid supplementation for three to six months ✓
- B Lifelong gluten-free diet
- C Intramuscular vitamin B12 alone
- D Pancreatic enzyme replacement
Correct answer: A. Tetracycline with folic acid supplementation for three to six months
Explanation
Tropical sprue occurs in residents of or visitors to tropical regions and causes malabsorption with folate deficiency producing megaloblastic anemia. Standard therapy is oral tetracycline for three to six months combined with folic acid, with substantial symptomatic improvement. The negative tTG and absence of intraepithelial lymphocytosis argue against coeliac disease, so a gluten-free diet is unwarranted. Isolated A12 replacement ignores the folate deficit and the underlying cause, and pancreatic function is normal here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.