Type 1 diabetes mellitus, coeliac disease, and lymphoma: a report of four cases.
BACKGROUND
Patients with Type 1 diabetes mellitus have a high prevalence of coeliac disease, symptoms of which are often mild, atypical, or absent. Untreated coeliac disease is associated with an increased risk of malignancy, particularly of lymphoma. We describe four patients with Type 1 diabetes mellitus and coeliac disease who developed lymphoma.


METHODS
Two patients were male and two female. In three patients, coeliac disease and lymphoma were diagnosed simultaneously. Enteropathy-associated T cell lymphoma occurred in two patients, Hodgkin's disease in one, and B cell lymphoma in one. Response to treatment was in general poor, and three patients died soon after the diagnosis of lymphoma was made.


CONCLUSIONS
As the relative risk of lymphoma is reduced by a gluten-free diet, a high index of suspicion for coeliac disease should exist in all Type 1 diabetic patients with unexplained constitutional or gastrointestinal symptoms.
O'Connor
T M
TM
Department of Medicine, Cork University Hospital, Wilton, Ireland. terryoconnor@tinet.ie
Cronin
C C
CC
Loane
J F
JF
O'Meara
N M
NM
Firth
R G
RG
Shanahan
F
F
O'Halloran
D J
DJ
D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008223:Lymphoma / Q000150:complications* / Q000175:diagnosis*; D016393:Lymphoma, B-Cell / Q000150:complications / Q000175:diagnosis; D016399:Lymphoma, T-Cell / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged