Elusive Gastric Atrophy in Children: Diagnostic Pitfalls and a Stepwise Approach.

Atrophic gastritis is an autoimmune gastritis that is characterised by the production of antibodies to parietal cells and intrinsic factor of the stomach. It is uncommon in paediatrics, as a result, is not usually in the differential diagnosis. A boy in middle childhood presented with a history of auditory hallucinations and fatigue, his workup only showed iron deficiency anaemia which responded to oral iron replacement but rebounded off therapy. There was no underlying cause found until years later, when he presented with Raynaud's phenomenon leading to an autoimmune workup being done which showed him being weakly antinuclear antibody (ANA) positive and strongly positive for antiparietal cell antibody. This led to the patient undergoing endoscopy where the histopathology findings revealed antral-like gastric mucosa with mild mixed chronic inflammation. There was a decrease in parietal cell numbers and t focal evidence of intestinal metaplasia, but no evidence of dysplasia or malignancy. This confirmed the diagnosis of atrophic gastritis which is extremely rare in the paediatric population.