eng Science and Education Publishing International Journal of Celiac Disease 2334-3486 2017-03-02 5 1 40 42 10.12691/ijcd-5-1-6 IJCD2017516 article Hugh J. Freeman hugfree@shaw.ca 1 Doug Webber 2 Departments of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada Department of Pathology, University of British Columbia, Vancouver, BC, Canada 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. http://pubs.sciepub.com/ijcd/5/1/6/ijcd-5-1-6.pdf celiac disease intra-epithelial lymphocytosis ileal biopsy colonic biopsy lymphocytic colitis microscopic enteritis lymphocytic ileitis