Celiac Disease Case Study Indicates Tumors May Influence Immunologic Reactions
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They recently reported on the case of a 72-year-old patient who suffered from celiac disease that had been diagnosed in his early fifties. The patient had not followed a gluten-free diet. Rather, he had eaten a normal diet. However, he showed no evidence of enteropathy or celiac-associated antibodies. Still, the patient developed a jejunal T-cell lymphoma.
Due to perforation, the team performed a resection, and added four courses of IMVP-16. The patient switched to a strict gluten-free diet. After two years, he presented with weight loss and a clonally divergent refractory sprue type II with loss of antigen (CD8; T-cell receptor-β) expression in intraepithelial lymphocytes.
At that point, even though he remained on a strict gluten-free diet, he showed elevated blood levels of celiac-associated antibodies.
The team notes several interesting facets to the case. First, the lack of enteropathy under a gluten-containing diet supports the notion that malignant diseases, especially non-Hodgkin lymphoma, trigger immune suppression.
Secondly, the fact that, while still on a strict gluten-free diet, the patient developed an early form of a second independent T-cell lymphoma (refractory sprue type II), coupled with the celiac-associated antibodies, raises the question whether the clonal intraepithelial lymphocytes might be stimulating antibody production.
Thus, taken alone, the detection of celiac-associated antibodies in patients with celiac disease is not sufficient to prove noncompliance with gluten-free diet.
Source: Digestion 2010;81:231-234 (DOI: 10.1159/000269810)
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