Een adolescent met ondervoeding, purpura en chronische diarree bij wie colitis ulcerosa werd aangetroffen

A 17-year-old boy presented with long-standing malnutrition, anaemia, purpura and chronic diarrhoea. He firmly believed that he was allergic to many types of nutrients – a belief in which he was supported by an alternative healer – and consequently he ate very little. Previous investigations carried out by an allergologist had excluded food allergies. The school management insisted further medical investigations should be carried out. The symptoms were caused by ulcerative colitis and an inadequate dietary intake. The purpura were due to vitamin C deficiency. Treatment involved immunosuppressive therapy and supplementary vitamins. Inflammatory bowel disease occurs relatively often during childhood and adolescence. As well as abdominal pain and bloody stools, it can present as a feeling of malaise and growth retardation. Illness-induced malnutrition can present as weight loss or stunting, or as disorders due to deficiencies in vitamins or minerals. When treating a chronic illness, one should be alert to general malnutrition, but also to specific deficiencies of micronutrients.