An 18-year old presented with recurrent episodes of diarrhea associated with epigastric discomfort and bloating. Examination Stool examination revealed trophozoites of the species Giardia lamblia. Gastro-duodenoscopy was performed. It revealed numerous nodules in the duodenum (refer image). Biopsies of multiple nodules were performed.
Histological examination revealed normal villi with prominent lymphoid follicles in the lamina propria. Further evaluation revealed low levels of IgG, IgA, and IgM in serum. What is the likely diagnosis? *This case is from Docplexus editorial team for educative purpose only. Source: NEJM Stay Connected, the answer will be posted in the next 48h!
