title: Self-limited coeliac-like enteropathy: a series of 18 cases highlighting another coeliac disease mimic.
abstract: OBJECTIVE
  To describe the clinical and pathological features of a series of patients with biopsy findings of a coeliac disease-like enteropathy in the setting of an acute illness.
  
  
  RESULTS
  Eighteen cases of an abrupt-onset, self-limited illness with coeliac-like enteropathy (SLCE) were collected prospectively. Medication reaction, immune disorder, food allergy and parasitic infection were excluded. Coeliac disease was excluded by the transient nature of the illness and absence of tissue transglutaminase (TTG) elevation (nine of nine) or human leucocyte antigen (HLA)-DQ2/DQ8 haplotype (eight of nine). Clinical symptoms were recorded and histopathological findings in all gastrointestinal sites were quantified. Findings in the duodenum were compared to a coeliac disease control group. In 12 cases the clinical diagnosis was infective enteritis, probably viral in type. In six cases, a definite diagnosis was not established. Histological differences from coeliac disease included intra-epithelial neutrophil infiltration (P < 0.001), fewer intra-epithelial lymphocytes (P = 0.038) and uniform or crypt predominant intra-epithelial lymphocytosis in SCLE. One case displayed pan-gastrointestinal tract lymphocytosis. All resolved within 6 months.
  
  
  CONCLUSIONS
  Histopathologists need to be aware that a coeliac disease-like enteropathy may occur in the setting of an acute gastrointestinal illness and resolve without sequelae.
authors.affiliation: Envoi Specialist Pathologists, Herston, Qld, Australia.|Anatomical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Qld, Australia.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Brown
authors.affiliation: Sullivan Nicolaides Pathology, Taringa, Qld, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bettington
authors.affiliation: Envoi Specialist Pathologists, Herston, Qld, Australia.|The Conjoint Gastroenterology Laboratory, Queensland Institute of Medical Research, Bancroft Centre, Herston, Qld, Australia.|School of Medicine, University of Queensland, Herston, Qld, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Bettington
authors.affiliation: Envoi Specialist Pathologists, Herston, Qld, Australia.|School of Medicine, University of Queensland, Herston, Qld, Australia.|Cancer and Population Studies Group, Queensland Institute of Medical Research, Bancroft Centre, Herston, Qld, Australia.
authors.forename: Christophe
authors.initials: C
authors.lastname: Rosty
mesh_terms: D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004386:Duodenum / Q000378:metabolism / Q000473:pathology; D005260:Female; D019204:GTP-Binding Proteins / Q000378:metabolism; D006683:HLA-DQ Antigens / Q000378:metabolism*; D006239:Haplotypes; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D008218:Lymphocytosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000378:metabolism
chemical_list: D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C063831:HLA-DQ6 antigen; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: coeliac disease; coeliac-like enteropathy; infection; intra-epithelial lymphocytosis; villous atrophy; viral enteritis