Hemoptysis and Hematuria in Sprue Importance of Vitamin K Metabolism

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Sprue (idiopathic steatorrhea, celiac disease, Gee-Herter disease) is not commonly encountered in nontropical regions. Sprue is considered a chronic deficiency state related to pernicious anemia and to deficient absorption of the erythrocyte-maturing factor, as well as to deficient absorption of fat-soluble substances. Hemoptysis and hematuria are rare complications. The case to be reported not only illustrates the lack of absorption of fat-soluble substances, including fat-soluble vitamins, particularly vitamin K, but also may illustrate deficient synthesis of vitamin K as a result of the use of succinylsulfathiazole, * which changes the bacterial flora in the intestinal tract.

In this instance the diagnosis of sprue was not established until the second period of observation. Until then the patient had been treated for indeterminate diarrhea. Three years previously an attack of prolonged diarrhea had promptly subsided upon sulfathiazole therapy, which suggested that bacillary dysentery might have been present. Nine days following our initial observation, the patient was readmitted to the hospital as an emergency case with hemoptysis and hematuria.

Case Report

A married white man, aged 31, a storekeeper by occupation, was referred by Dr. J. T. Ledman of Lakewood, Ohio to Dr. J. W. Thomas for allergic investigation. The patient complained of lower abdominal cramplike pain, persistent diarrhea, weakness, and loss in weight.

During the previous 4 months he had had as many as 9 stools daily without observing blood. He had lost 20 pounds in weight. A similar condition 3 years previously had lasted 8 months. Sulfathiazole had been given for. . .



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