[Endemic celiac sprue and Hodgkin's disease in a 72-year-old patient].
METHODS
A 72-year-old man was admitted with diarrhea, loss of weight and anemia. The diarrhea started after antibiotic treatment of a pneumonia and persisted for 6 months at admission. Monoclonal gammopathy was found on external examination.


METHODS
The work-up yielded iron deficiency anemia, monoclonal gammopathy (IgG kappa) and elevated polyclonal IgA due to Gliadin- and endomysium-antibodies. Duodenal mucosa biopsies showed villous atrophy and increased intraepithelial lymphocytes. Celiac disease was diagnosed. Unexpectedly, mediastinal lymphomas were found and the concomitant diagnosis of Hodgkin's disease was made.


METHODS
On gluten free diet all symptoms of malabsorption resolved. Therapy for the Hodgkin lymphoma with chemotherapy was initiated. As Bleomycin associated lung disease occurred during therapy, radiotherapy was not administered. A complete remission could be achieved.


CONCLUSIONS
The association of celiac disease and malignancy is well known. The pathogenesis is not fully understood, but a correlation between the duration of gluten exposure and the rate of malignancy was found. Thus, the chronic immunologic stimulation might also have contributed to the development of Hodgkin's disease in our patient, which to date has been reported only anecdotally.
Platen
E
E
Medizinische Klinik und Poliklinik I der Universität Bonn, Allgemeine Innere Medizin, Germany.
Dumoulin
F L
FL
Fischer
H P
HP
Sauerbruch
T
T
D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000150:complications; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects; D003967:Diarrhea / Q000209:etiology; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D006689:Hodgkin Disease / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D010265:Paraproteinemias / Q000150:complications; D011658:Pulmonary Fibrosis / Q000139:chemically induced; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects
D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin