eng Science and Education Publishing International Journal of Celiac Disease 2334-3486 2021-05-17 9 2 38 40 10.12691/ijcd-9-2-5 IJCD2021925 article Hugh James Freeman hugfree@shaw.ca 1 Michael Nimmo 1 Departments of Medicine (Gastroenterology) and Pathology, University of British Columbia, Vancouver, BC, Canada A 43-yr old female with two prior renal transplants for renal failure associated with diabetes, retinopathy and coronary artery disease developed diarrhea. Her medications included mycophenolate mofetil, an immunosuppressive medication documented to cause sprue-like mucosal changes in the small intestine. Later studies revealed a small intestinal mucosal lesion characterized by marked crypt hyperplasia, villous atrophy and increased intra-epithelial lymphocytes. Serological studies for celiac disease were negative and repeated biopsies despite a strict gluten-free diet, revealed histopathological persistence of a severely abnormal sprue-like enteropathy. Eventually, further biopsies of her small intestine revealed superimposed changes characterized by dense sub-epithelial collagen deposits histochemically staining positive for trichrome, typical of collagenous sprue and representing an expansion of published pathological features of mycophenolate-associated small intestinal mucosal disease. http://pubs.sciepub.com/ijcd/9/2/5/ijcd-9-2-5.pdf celiac disease sprue-like intestinal disease collagenous sprue mycophenolate immunosuppressants refractory sprue