Self-limited coeliac-like enteropathy: a series of 18 cases highlighting another coeliac disease mimic

• Published in: Histopathology 2016-01, Vol.68 (2), p.254-261
• Main Authors: Brown, Ian S, Bettington, Andrew, Bettington, Mark, Rosty, Christophe
• Format: Article
• Language: English
• Subjects: Adult; Aged; Celiac Disease - diagnosis; Celiac Disease - metabolism; Celiac Disease - pathology; Child; Child, Preschool; coeliac disease; coeliac-like enteropathy; Diagnosis, Differential; Duodenum - metabolism; Duodenum - pathology; Female; GTP-Binding Proteins - metabolism; Haplotypes; HLA-DQ Antigens - metabolism; Humans; infection; Intestinal Diseases - diagnosis; Intestinal Diseases - metabolism; Intestinal Diseases - pathology; intra-epithelial lymphocytosis; Lymphocytosis - pathology; Male; Middle Aged; Prospective Studies; Transglutaminases - metabolism; villous atrophy; viral enteritis
• ISSN: 0309-0167; 1365-2559
• DOI: 10.1111/his.12752

Aims To describe the clinical and pathological features of a series of patients with biopsy findings of a coeliac disease‐like enteropathy in the setting of an acute illness. Methods and results Eighteen cases of an abrupt‐onset, self‐limited illness with coeliac‐like enteropathy (SLCE) were collected prospectively. Medication reaction, immune disorder, food allergy and parasitic infection were excluded. Coeliac disease was excluded by the transient nature of the illness and absence of tissue transglutaminase (TTG) elevation (nine of nine) or human leucocyte antigen (HLA)‐DQ2/DQ8 haplotype (eight of nine). Clinical symptoms were recorded and histopathological findings in all gastrointestinal sites were quantified. Findings in the duodenum were compared to a coeliac disease control group. In 12 cases the clinical diagnosis was infective enteritis, probably viral in type. In six cases, a definite diagnosis was not established. Histological differences from coeliac disease included intra‐epithelial neutrophil infiltration (P