A 40-year-old man living in coastal southern India presents with chronic diarrhea, abdominal cramps, and weight loss over 18 months. Evaluation shows megaloblastic anemia with low serum folate and B12, and jejunal biopsy shows partial villous atrophy extending into the ileum. Coeliac serology is negative. What is the standard treatment?
- A Gluten-free diet alone
- B Tetracycline plus folic acid for 3 to 6 months ✓
- C Metronidazole for 7 days
- D Albendazole plus vitamin B12 injections
Correct answer: B. Tetracycline plus folic acid for 3 to 6 months
Explanation
Tropical sprue affects residents of or visitors to tropical regions, notably southern India, and causes malabsorption with megaloblastic anemia due to combined folate and B12 deficiency. Histology shows villous atrophy involving jejunum and ileum, unlike coeliac disease which spares the distal ileum. Standard therapy is tetracycline for 3 to 6 months together with folic acid supplementation. A short course of metronidazole treats giardiasis, not sprue, and a gluten-free diet addresses coeliac disease, excluded here by negative serology.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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