Jefferson Adams is a freelance writer living in San Francisco. His poems, essays and photographs have appeared in Antioch Review, Blue Mesa Review, CALIBAN, Hayden's Ferry Review, Huffington Post, the Mississippi Review, and Slate among others.
He is a member of both the National Writers Union, the International Federation of Journalists, and covers San Francisco Health News for Examiner.com.
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.