Table 1 Evaluation of a toddler with recurrent fever.

WBC 13.4 K/mm³; 57% N, 0.6% B, 36% L, 1.9% E, 4% M

Hgb 13.1 g/dL, Hct 36.5%, MCV 76.5 Fl

ESR 14 mm/hr ; ANA negative

AST 37 U/L; ALT 27 U/L; TBILI 0.1 mg/dL

U/A Protein negative; <1 WBC/HPF; <1 RBC/HPF

TSH 2.44 uIU/mL; Free T4 1.11 ng/dL

IgG 963 mg/dL; IgA 29 mg/dL; IgM 125 mg/dL

Tissue transglutaminase IgA antibody 78.7 U/mL (nl < 3.9)

Urine VMA/HVA panel 7.1 mcg/mg Cr, 17.7 mcg/mg Cr (nl < 18.0, < 23.0)

E. Histolytic antibody screen negative

Rotavirus stool antigen negative

Toxoplasma IgG/IgM negative

Brucella IgG/IgM negative

Bartonella Henselae IgG/IgM negative

Abdominal ultrasound normal

Chest roentgenogram normal

Right knee roentgenogram normal

Disaccharides panel (endoscopy)

Lactase 3.17 umol/g/min (nl > 6.6)

Maltase 40.69 umol/g/min (nl > 40.2)

Sucrase 11.12 umol/g/min (nl > 11.3)

Palatinase 2.2 umol/g/min (nl > 2.9)

Glucoamylase 42.27 umol/g/min (nl > 25)

Duodenal endoscopic biopsy

   Marked villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes consistent with celiac disease.

CIAS1 gene analysis positive

   A heterozygous G-->A change in the coding sequence of exon 3 identified

MVK/HIDS gene analysis negative

TNFRSF1A gene analysis (TRAPS) negative

MEFV (FMF) gene analysis negative