A 35-year-old man returning from rural South India has chronic diarrhoea with steatorrhoea and megaloblastic anaemia. Duodenal biopsy shows partial villous atrophy. Anti-tissue transglutaminase antibody is negative. He improves dramatically on tetracycline with folic acid. What is the most likely diagnosis?
- A Coeliac disease
- B Tropical sprue ✓
- C Intestinal lymphangiectasia
- D Autoimmune enteropathy
Correct answer: B. Tropical sprue
Explanation
Tropical sprue occurs in residents or visitors to endemic tropical regions and responds to prolonged tetracycline with folate supplementation. Megaloblastic anaemia from combined folate and B12 deficiency is characteristic. Coeliac disease is excluded by negative anti-tTG antibodies and by response to antibiotics rather than gluten withdrawal. Lymphangiectasia causes protein-losing enteropathy and does not respond to tetracycline.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.