A Young Man with Anemia and Recurrent Tachyarrhythmic Episodes

28 mm/h, normal total bilirubin, serum creatinine 0.65 mg/dl, total protein 7.1 g/dl, normal IgA, IgM and IgG concentrations and serum albumin of 3.4 g/dl. Anti-gliadin antibody tests were negative, but the IgA endomysium assay and anti-tissue transglutaminase antibody tests were not performed. Urinalysis was negative. A chest Xray showed neither pleural-parenchymal alterations nor cardiomegaly. An electrocardiogram revealed sinus tachycardia. Search for fecal occult blood (in 3 stool samples) was negative. Abdominal echography revealed no alterations or free abdominal effusion. Colonoscopy was unremarkable. In esophagogastroduodenoscopy, there were no stomach lesions but duodenal bleeding due to hemorrhagic telangiectasia; duodenal biopsy evidenced a nonspecific chronic duodenitis pattern without any other structural alterations. 99m Tc-labeled red blood cell scintigraphy did not show any pathological accumulation suggestive of intestinal hemorrhage. The patient was given intravenous iron and received 4 units of red blood cell concentrates. At discharge, he had a stable Hb value of 8.4 g/dl. During the following years, the patient was in good clinical condition and only suffered from exercise-induced dyspnea [MMRCDS (Modified Medical Research Case Report