4-kg Unintentional Weight Loss in Medicine / Internal Medicine — 21yo Man | Gastroenterology | SMLE Q#13569
SMLE Question #13569
Medicine / Internal Medicine
Gastroenterology
Objective: OBJ-433
Last updated: February 2026
A 21-year-old man has 4 months of intensely pruritic rash on the extensor surfaces of both elbows, abdominal bloating, and non-bloody diarrhea 3–4 times daily with 4-kg unintentional weight loss and fatigue. Examination shows excoriated erythematous papulovesicular lesions over the elbows and pallor. Upper endoscopy shows scalloping of the duodenal folds, and duodenal biopsy shows subtotal villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes. What is the most appropriate next step in management for this patient?
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