Answer 2 Celiac sprue. This patient has a malabsorption syndrome accompanied by polyarthritis. The differential diagnoses includes inflammatory bowel disease, Whipple’s disease, and celiac sprue. Villous atrophy on biopsy along with the rash on the patient’s arms, known as dermatitis herpetiformis, indicate a diagnosis of celiac sprue. Treatment consists of a gluten-free diet. Inflammatory bowel disease is less likely because the diarrhea is not bloody. Whipple’s disease is incorrect because the patient does not have lymphadenopathy. Irritable bowel syndrome is not associated with joint pains. Dysentery would have a more acute presentation with bloody diarrhea. Click here to return to the questions

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