In June, 2006, an 18-month-old Latina girl presented to our hospital with non-bloody, non-bilious vomiting, She had been vomiting for 3 months: daily for the first 2 weeks, and then every 4-5 days (although several times a day, on the days when she did vomit). During this period, her weight had decreased by about 0 5 kg. Before the vomiting began, she had been cruising and talking. However, at presentation, she was able only to crawl, and could speak only four oi five words. During her illness, she had visited a paediatrician on several occasions, and been given various diagnoses, including otitis media, gastroenteritis and bronchitis; she had, accordingly, received three courses of antibiotics. She had no previous illnesses of note; there was no histoiy of fever, cough, travel, or visitors from overseas. She had received all the standard vaccinations for a girl of her age, including those against diphtheria, pertussis, tetanus, polio, hepatitis B, Haemophilus influenzas type b, measles, mumps, rubella, varicella, and pneumococcus. She was born in the USA.
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