Diagnosing celiac disease: a review of diagnostic modalities of celiac disease

Celiac disease is known as gluten-sensitive enteropathy. By enteropathy it simply means it is pathology of the gastrointestinal tract and that is why diarrhea (a common GI symptom) is usually one of the commonest presentations of celiac disease. So, it is safe to define celiac disease as an autoimmune disorder that mainly afflicts the small intestine. By autoimmune authors are referring to a disorder in which the body’s immune system works against the body itself. It is a chronic disorder where the sufferer is not able to tolerate gliadin, which is the alcohol soluble component of gluten. Gluten of course is a protein that is usually found in common foods like barley and wheat. Celiac disease which can also be regarded as celiac sprue has a genetic and immunological aspect to its etiology both of which would need to be considered when screening anyone for celiac disease.

EBV-Associated Lymphoproliferative Disorder and Hemophagocytic Lymphohistiocytosis in a Patient with Severe Celiac Disease

Background. Epstein-Barr virus- (EBV-) associated lymphoproliferative disease (LPD) is a rare condition, usually occurring in immunocompromised patients. We report a case of EBV-associated LPD in a patient with severe celiac disease, the first report to describe this syndrome in a patient with this diagnosis.Case Summary. A 69-year-old Caucasian woman with recent diagnosis of celiac sprue presented to our hospital with persistent diarrhea, abdominal pain, weight loss, and fatigue despite adherence to gluten-free diet for a number of weeks prior to presentation. She underwent evaluation for occult malignancy and was found to have diffuse intra-abdominal mesenteric lymphadenopathy on CT scan. Biopsy of mesenteric nodes revealed an EBV positive, CD20 positive mixed lymphoproliferative process with T-cell predominance, but without a monoclonal cell population felt to be consistent with EBV-associated LPD. Bone marrow biopsy revealed hemophagocytic lymphohistiocytosis, complicating her course. She was treated with steroids and rituximab but continued to decline, eventually developing MSSA bacteremia and succumbing to her disease.Conclusion. To our knowledge, this is the first report of the constellation of celiac sprue, EBV-associated LPD, and hemophagocytic lymphohistiocytosis. Providers caring for patients with severe, uncontrolled celiac disease and adenopathy should consider EBV-associated LPD.