International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
Go
International Journal of Celiac Disease. 2017, 5(1), 40-42
DOI: 10.12691/ijcd-5-1-6
Open AccessCase Report

Intra-epithelial Lymphocytosis of the Ileum: A Pathological Clue to Clinically Occult Adult Celiac Disease

Hugh J. Freeman1, and Doug Webber2

1Departments of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada

2Department of Pathology, University of British Columbia, Vancouver, BC, Canada

Pub. Date: March 02, 2017

Cite this paper:
Hugh J. Freeman and Doug Webber. Intra-epithelial Lymphocytosis of the Ileum: A Pathological Clue to Clinically Occult Adult Celiac Disease. International Journal of Celiac Disease. 2017; 5(1):40-42. doi: 10.12691/ijcd-5-1-6

Abstract

A 39-yr-old male presented with diarrhea, weight loss and rectal bleeding. Hemorrhoids were present but the colon and distal ileum were macroscopically normal. Random mucosal biopsies of the ileum and multiple sites in the colon revealed extensive ileal and focal cecal intra-epithelial lymphocytosis. Subsequent duodenal mucosal biopsies confirmed the suspicion of adult celiac disease. Later endoscopic biopies done after gluten-free diet treatment were normal. This report demonstrates that intra-epithelial lymphocytosis in the ileum may be an important pathological clue to underlying clinically occult adult celiac disease.

Keywords:
celiac disease intra-epithelial lymphocytosis ileal biopsy colonic biopsy lymphocytic colitis microscopic enteritis lymphocytic ileitis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol 2012; 18: 4823-4854.
 
[2]  Freeman HJ. Small intestinal mucosal biopsy for investigation of diarrhea and malabsorption in adults. Gastrointest Endosc Clin N Am 2000; 10: 739-753.
 
[3]  Wolber R. Owen D, Delbuono L, Appelman H, Freeman H. Lymphocytic gastritis in patients with celiac sprue or spruelike intestinal disease. Gastroenterology 1990; 98: 310-315.
 
[4]  Dickey W, Hughes DF. Histology of the terminal ileum in celiac disease. Scand J Gastroenterol 2004: 39: 663-667.
 
[5]  Hopper AD, Hulstone DP, Leeds JS, McAlindon ME, Dube AK, Stephenson TJ, Sanders DS. The occurrence of terminal ileal histological abnormalities in patients with celiac disease. Dig Liver Dis 2006; 38: 813-819.
 
[6]  Wolber R, Owen D, Freeman H. Colonic lymphocytosis in patients with celiac sprue. Hum Pathol 1990; 21: 1092-1096.
 
[7]  MacDonald WC, Brandborg LL, Flick AL, Trier JS, Rubin CE. Studies of celiac sprue. IV. The response of the whole length of the small bowel to a gluten-free diet. Gastroenterology 1964; 47: 573-589.
 
[8]  Tyler AD, Murdoch TB, Riddell RH, Cohen Z, Silverberg MS. Celiac disease detected by pouch biopsy of a patient with ileal pouch-anal anastomosis. Am J Gastroenterol 2011; 106: 1367-1368.
 
[9]  Schaeffer DF, Walsh JC, Tyler AD, Ben-Bassat O, Silverberg MS, Riddell RH, Kirsch R. Intraepithelial lymphocytosis is a frequent finding in biopsies from ileal pouch-anal anastomoses. Hum Pathol 2016; 54: 31-36.