Clinical manifestations and gastrointestinal pathology in 40 patients with autoimmune enteropathy

• Published in: Clinical immunology (Orlando, Fla.) Vol. 207; pp. 10 - 17
• Main Authors: Villanacci, Vincenzo, Lougaris, Vassilios, Ravelli, Alberto, Buscarini, Elisabetta, Salviato, Tiziana, Lionetti, Paolo, Salemme, Marianna, Martelossi, Stefano, De Giacomo, Costantino, Falchetti, Diego, Pelizzo, Gloria, Bassotti, Gabrio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2019
• Subjects: Adolescent; Adult; Aged; Autoimmune enteropathy (AIE); Celiac disease; Child; Child, Preschool; Duodenum; Female; Gastrointestinal Tract - pathology; Humans; Male; Middle Aged; Polyendocrinopathies, Autoimmune - pathology; Primary immunodeficiencies (PIDs); Retrospective Studies; Young Adult; CD; g-i; Autoimmune enteropathy (AIE); Duodenum; H&E; PID; CMV; GHVD; Celiac disease; CVID; ANA; IPEX; ASMA; p ANCA; AIE; Primary immunodeficiencies (PIDs); APECED
• ISSN: 1521-6616; 1521-7035
• DOI: 10.1016/j.clim.2019.07.001

Autoimmune enteropathy (AIE) is a rare condition that may affect pediatric and adult patients, frequently associated with primary immunodeficiencies. We performed a retrospective study on clinical and histological findings from 40 AIE patients. Histological presentation showed a prevalent celiac disease pattern (50%), followed by the mixed pattern (35%), independently of age, chronic active duodenitis (10%), and GVHD-like pattern (5%). Patients with primary immunodeficiencies (24/40) presented mainly with the celiac disease pattern (72.2% versus 22.2%; p < .0001), while patients without primary immunodeficiencies presented with a mixed histological pattern (61.1% versus 13.6%; p < .0001). Our study shows that the prevalent histological presentation is the celiac disease-like pattern, independently of age, and, for the first time, that the histological presentation of AIE differs significantly between patients with and without primary immunodeficiencies. These findings may be helpful for more precise and timely diagnosis and management of this rare disorder.
•The prevalent histological presentation od AIE is celiac-disease like.•There are no differences in histological presentation between pediatric and adult patients.•Patients with primary immunodeficiencies have a distinct histological presentation.