Unexpected Diagnosis of Tropical Sprue in a Nonendemic Region: A Case Report

Tropical sprue (TS) is a rare malabsorption disorder primarily seen in tropical regions, often presenting with chronic diarrhea, weight loss, and nutrient deficiencies. Due to its overlapping symptoms with other gastrointestinal conditions, TS remains a diagnostic challenge, especially in nonendemic areas. We report a 14‐year‐old Ethiopian female with no history of travel who presented with a four‐month history of chronic diarrhea, abdominal pain, and severe acute malnutrition (SAM). Laboratory tests revealed macrocytic anemia (hemoglobin 7.4 g/dL, MCV 106 fL) with low folic acid, vitamin B12, and iron levels. A terminal ileum biopsy demonstrated villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes, and mild inflammation. Celiac disease was excluded via negative anti–tissue transglutaminase (tTG) serology and the successful reintroduction of gluten. She was treated with nutritional supplementation and a three‐month course of doxycycline, leading to full clinical recovery without recurrence. To our knowledge, this is the first documented case of TS in Ethiopia in a patient with no international travel history. This case underscores the importance of considering TS in patients with unexplained malabsorption, even in nonendemic regions. The favorable response to antibiotics further supports an infectious etiology. Increased awareness and timely diagnosis are essential for optimal management.