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

Hugh J. Freeman^1, and Doug Webber²

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

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

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

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