A new cause of 'non-responsiveness' in coeliac disease?

• Published in: Postgraduate medical journal Vol. 76; no. 894; pp. 227 - 229
• Main Authors: Jennings, J S R, Wyatt, J I, Howdle, P D
• Format: Journal Article
• Language: English
• Published: London The Fellowship of Postgraduate Medicine 01-04-2000; BMJ; Oxford University Press; BMJ Group
• Subjects: Adult; Biological and medical sciences; Bone marrow; Celiac disease; Celiac Disease - complications; Celiac Disease - diet therapy; coeliac disease; Diet; Digestive system; Gluten; gluten sensitivity; Humans; Intestine, Small - pathology; Investigative techniques, diagnostic techniques (general aspects); leukaemia; Leukemia, Myelomonocytic, Chronic - diagnosis; Leukemia, Myelomonocytic, Chronic - pathology; Leukemic Infiltration - complications; Leukemic Infiltration - diagnosis; Male; Medical sciences; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Short Report; Small intestine; Treatment Failure; villous atrophy; Human; Immunopathology; Nutrition; Non response; Coeliac disease; Case study; Pathology; Diet; Intestinal malabsorption; Biopsy; Etiology; Risk factor; Digestive diseases; Intestinal disease; Diagnosis
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pmj.76.894.227

A 42 year old man presented with gluten-responsive coeliac disease and secondary pancreatic insufficiency. Subsequently his symptoms relapsed and repeat small intestinal biopsy showed villous atrophy and infiltration by leukaemic cells, despite continuation of a gluten-free diet. Serious causes of relapse and non-responsiveness in coeliac disease include enteropathy-associated T-cell lymphoma, ulcerative jejunitis and an end-stage hypoplastic mucosa. This is the first report of non-responsiveness due to infiltration by leukaemia.