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Celiac Disease Case Study Indicates Tumors May Influence Immunologic Reactions

Celiac.com 02/16/2010 - A team of German clinicians recently noted a case that indicates that tumors may influence immunologic reactions. The team included F. Mühr-Wilkenshoffa, M. Friedricha, H.-D. Fossb, M. Hummelb, M. Zeitza, and S. Dauma. They are associated with the Medical Clinic I, Gastroenterology, Rheumatology and Infectious Diseases, and with the Department of Pathology, Charité  at University Medicine Berlin.

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.

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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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