Peter Dellatore, MD1, Kevin Skole, MD2
1Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; 2University Medical Center of Princeton at Plainsboro, Plainsboro Township, NJ
Introduction: Lymphocytic enteritis (LE), a subclassification of microscopic enteritis (ME), is defined as abnormal infiltration of intraepithelial lymphocytes (IELs) in the gastrointestinal mucosa. Causes include gluten exposure, H. pylori (Hp) infection, small intestinal bacterial overgrowth, autoimmune conditions, irritable bowel syndrome, or medications such as proton pump inhibitor (PPI), NSAIDs, and selective serotonin reuptake inhibitors. A majority of cases are found in the colon or duodenum; we report a rare case of jejunal LE.
Case Description/Methods: A 51-year-old man with untreated Hp and diabetic gastroparesis, on chronic pantoprazole, presented with chronic intermittent watery diarrhea, diffuse abdominal pain, nausea, vomiting, and generalized malaise. A CT showed jejunal mucosal thickening. The jejunal mucosa appeared normal by deep enteroscopy; a subsequent colonoscopy was also normal. Jejunal pathology demonstrated IELs with normal villous architecture consistent with LE; colon biopsies were negative for IEL. Laboratory tests were remarkable for iron deficiency anemia, but otherwise negative for other nutritional deficiencies, transglutaminase antibodies, or IgA deficiency. The patient received 10 days of solumedrol and concomitant Hp therapy; the PPI was then stopped. His diarrhea improved and repeat enteroscopy demonstrated resolution of jejunal LE.
Discussion: LE is a rarely diagnosed subclass of ME, but growing epidemiologic trend confirms that it will become a common condition in clinical practice. Multiple potential causes have been identified and treatment includes steroids, and/or addressing the underlying cause. Our patient had at least two potential causes: Hp and PPI use. Due to the unusual location of his LE and his severe illness, we treated multiple possible causes at the same time, with notable clinical and histologic improvement. This case demonstrates the success of standard treatment modalities for a unique anatomical location of a rare condition. With increasing disease prevalence, LE represents a novel entity that warrants further investigation. Subsequent care will be dictated by his clinical course, and repeat biopsies if necessary.
Citation: Peter Dellatore, MD; Kevin Skole, MD. P1735 - JEJUNAL LYMPHOCYTIC ENTERITIS: AN UNUSUAL LOCATION FOR A RARE CONDITION. Program No. P1735. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.