Free perforation of the small intestine in collagenous sprue.
A 67-year-old man with celiac disease developed recurrent diarrhea, profound weakness and weight loss, with evidence of marked protein depletion. His clinical course was refractory to a strict gluten-free diet and steroid therapy. Postmortem studies led to definition of unrecognized collagenous sprue that caused ulceration and small intestinal perforation. Although PCR showed identical monoclonal T-cell populations in antemortem duodenal biopsies and postmortem jejunum, careful pathological evaluation demonstrated no frank lymphoma. Rarely, overt or even cryptic T-cell lymphoma may complicate collagenous sprue, however, small intestinal ulcers and perforation may also develop independently. The dramatic findings here may reflect an underlying or early molecular event in the eventual clinical appearance of overt T-cell lymphoma.
Freeman
Hugh J
HJ
Department of Medicine Gastroenterology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC V6T 1W5, Canada. hugfree@shaw.ca
Webber
Douglas L
DL
D000368:Aged; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy / Q000473:pathology; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000150:complications / Q000473:pathology; D055050:Diet, Gluten-Free; D017809:Fatal Outcome; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007416:Intestinal Perforation / Q000209:etiology* / Q000473:pathology; D008297:Male; D015431:Weight Loss