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Type I refractory sprue
60 years
The patient does not comply with a gluten free diet since 6 months. Anti-gliadine and anti-transglutaminase antibodies are in a normal range. Gastroscopy showed no major findings.
Intraepithelial lymphocytosis without villous atrophy of the duodenal mucosa (Marsh type I). Slight hypertrophy of the crypts. In the IHC staining most lymphocytes are CD3 and CD8 double positive.
For HE stain see slide ID: 1545 For CD3 IHC see slide ID: 1546
Sprue is a rare form of small bowel enteropathy characterized by chronic diarrhea and progressive malabsorption with little data available on its natural history. The pathologic lesion consists of variable alterations in villous architecture. Additionally the patient shows collagenous colitis, the combination with celiac disease is well known in the literature (see also appended reference).
Breen EG, Farren C, Connolly CE, McCarthy CF. Collagenous colitis and coeliac disease.
Gut. 1987 Mar;28(3):364. PubMed PMID: 3570042; PubMed Central PMCID: PMC1432690.
Link: http://www.ncbi.nlm.nih.gov/pubmed/3570042
Joël Gsponer
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