Immune modulation by non-hodgkin lymphoma in a patient with two primary intestinal T-cell lymphomas and long-standing celiac disease.
Tumors may influence immunologic reactions. Here, we report on a 72-year-old patient who suffered from celiac disease (CD) that had been diagnosed 20 years before. Under a normal diet but without any evidence of enteropathy or CD-associated antibodies, the patient developed a jejunal T-cell lymphoma. It was resected due to perforation and four courses of IMVP-16 were added. The patient started and kept a strict gluten-free diet (GFD). Two years later, he presented with weight loss and a clonally divergent refractory sprue type II with loss of antigen (CD8; T-cell receptor-beta) expression in intraepithelial lymphocytes. At this time point, he showed high titers of CD-associated antibodies, although he was on a strict GFD. This case report highlights several questions: the missing enteropathy under a gluten-containing diet supports the notion of immune suppression in malignant diseases, especially non-Hodgkin lymphoma. Secondly, the patient developed an early form of a second independent T-cell lymphoma (refractory sprue type II) under a strict GFD, then with CD-associated antibodies, which raises the question whether the clonal intraepithelial lymphocytes were stimulating antibody production. Thus, the single detection of CD-associated antibodies in patients with CD is not itself proof of noncompliance with GFD.
Mühr-Wilkenshoff
F
F
Medical Clinic I, Gastroenterology, Rheumatology and Infectious Diseases, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
Friedrich
M
M
Foss
H-D
HD
Hummel
M
M
Zeitz
M
M
Daum
S
S
D000368:Aged; D001707:Biopsy, Needle; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy / Q000276:immunology*; D055050:Diet, Gluten-Free; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D017809:Fatal Outcome; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D007150:Immunohistochemistry; D056747:Immunomodulation / Q000502:physiology*; D007580:Jejunal Neoplasms / Q000150:complications / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D016399:Lymphoma, T-Cell / Q000150:complications / Q000276:immunology* / Q000473:pathology; D008297:Male; D012720:Severity of Illness Index