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Canadian Journal of Gastroenterology
Volume 18, Issue 5, Pages 329-332
http://dx.doi.org/10.1155/2004/583484
Brief Communication

Synchronous Collagenous Sprue and Enteropathy-Type T Cell Lymphoma: Variants of the Same Disease

SAC Medlicott,1 PL Beck,2 S Loken,1 and T Crabtree1

1Calgary Laboratory Services, Peter Lougheed and Foothills Medical Centre, Calgary, Alberta, Canada
2Department of Gastronterology, Peter Lougheed and Foothills Medical Centre, Calgary, Alberta, Canada

Received 2 January 2004; Accepted 19 March 2004

Copyright © 2004 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 64-year-old man with treated hypothyroidism had 10 months of diarrhea, abdominal pain, anorexia and recent involuntary 13.6 kg weight loss. He presented to hospital with an acute abdomen that had a radiological correlate of free air under the diaphragm. He was diagnosed with a perforated mid-jejunum due to an ulcerated enteropathy-type T cell lymphoma (ETL), complicating collagenous sprue and cryptic celiac disease. Polymerase chain reaction verified monoclonal g- and b-T cell receptor gene rearrangements in the neoplasm. He had a complete resolution of symptoms when treated with a gluten-free diet in the postoperative period. This is apparently the first report describing collagenous sprue and ETL as synchronous lesions. Because atypical CD8+ lymphocytes are in both the collagenous sprue epithelium and ETL, the implication is that collagenous sprue is a noninvasive component of the ETL.