title: A case series in patients with enteropathy and granulomatous diseases.
abstract: BACKGROUND
  Although sarcoidosis and celiac disease are both chronic immunologic disorders involving multiple organ systems, reports about association of diseases in individual patients are sparse. While sarcoidosis is a chronic granulomatous disease presumably reflecting an exaggerated response to an unknown antigen, celiac disease is a T cell-driven disease triggered by ingestion of gluten, a protein composite found in wheat and related grains.
  
  
  METHODS
  We present three cases with a longstanding history of sarcoidosis that have been additionally diagnosed with celiac-like enteropathy. In two cases, celiac disease was established applying celiac-specific serology and duodenal histology, while one case was revealed as an AIE-75-positive autoimmune enteropathy. The HLA-DR3/DQ2 haplotype was confirmed in both celiac patients, hence confirming previous data of linkage disequilibrium as a cause for disease association. Remarkably, one celiac patient presented with granulomatous nodulae in the ileum, thus reflecting an intestinal sarcoid manifestation. In contrast the patient with an autoimmune enteropathy, was HLA-DQ9/DQ6-positive, also arguing against CD.
  
  
  CONCLUSIONS
  Associations of sarcoidosis and celiac disease are rare but do occur. Determining the HLA status in patients with complex autoimmune associations might help classifying involved disease entities.
authors.affiliation: Medical Department I (Gastroenterology, Infectious Diseases, Rheumatology), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany. tassilo.kruis@charite.de.
authors.forename: Tassilo
authors.initials: T
authors.lastname: Kruis
authors.affiliation: Institute for Pathology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany. korinna.joehrens@charite.de.
authors.forename: Korinna
authors.initials: K
authors.lastname: Jöhrens
authors.affiliation: Medical Department I (Gastroenterology, Infectious Diseases, Rheumatology), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany. verena.moos@charite.de.
authors.forename: Verena
authors.initials: V
authors.lastname: Moos
authors.affiliation: Department for Psychiatry, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany. imke.puls@charite.de.
authors.forename: Imke
authors.initials: I
authors.lastname: Puls
authors.affiliation: Medical Department I (Gastroenterology, Infectious Diseases, Rheumatology), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany. britta.siegmund@charite.de.
authors.forename: Britta
authors.initials: B
authors.lastname: Siegmund
authors.affiliation: Medical Department I (Gastroenterology, Infectious Diseases, Rheumatology), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany. severin.daum@charite.de.
authors.forename: Severin
authors.initials: S
authors.lastname: Daum
authors.affiliation: Medical Department I (Gastroenterology, Infectious Diseases, Rheumatology), Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany. michael.schumann@charite.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Schumann
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D003937:Diagnosis, Differential; D005260:Female; D006683:HLA-DQ Antigens / Q000097:blood; D006239:Haplotypes; D006801:Humans; D008171:Lung Diseases / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D008875:Middle Aged; D016884:Polyendocrinopathies, Autoimmune / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D012507:Sarcoidosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000276:immunology
chemical_list: D015415:Biomarkers; D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C063831:HLA-DQ6 antigen; C415982:HLA-DQ9 antigen