Immune Modulation by Non-Hodgkin Lymphoma in a Patient with Two Primary Intestinal T-Cell Lymphomas and Long-Standing Celiac DiseaseMühr-Wilkenshoff F. · Friedrich M. · Foss H.-D. · Hummel M. · Zeitz M. · Daum S.
aMedical Clinic I, Gastroenterology, Rheumatology and Infectious Diseases, and bDepartment of Pathology, Charité – University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
Tumors may influence immunologic reactions. Here, we report on a 72-year-old patient who suffered from celiac disease (CD) that had been diagnosed 20 years before. Under a normal diet but without any evidence of enteropathy or CD-associated antibodies, the patient developed a jejunal T-cell lymphoma. It was resected due to perforation and four courses of IMVP-16 were added. The patient started and kept a strict gluten-free diet (GFD). Two years later, 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 this time point, he showed high titers of CD-associated antibodies, although he was on a strict GFD. This case report highlights several questions: the missing enteropathy under a gluten-containing diet supports the notion of immune suppression in malignant diseases, especially non-Hodgkin lymphoma. Secondly, the patient developed an early form of a second independent T-cell lymphoma (refractory sprue type II) under a strict GFD, then with CD-associated antibodies, which raises the question whether the clonal intraepithelial lymphocytes were stimulating antibody production. Thus, the single detection of CD-associated antibodies in patients with CD is not itself proof of noncompliance with GFD.
PD Dr. med. Severin Daum, MD
Medical Clinic I, Gastroenterology, Rheumatology and Infectious Diseases
Charité – University Medicine Berlin, Campus Benjamin Franklin
Hindenburgdamm 30, DE–12200 Berlin (Germany)
Tel. +49 30 8445 2347, Fax +49 30 8445 4481, E-Mail email@example.com
Published online: January 29, 2010
Number of Print Pages : 4
Number of Figures : 1, Number of Tables : 1, Number of References : 17
Digestion (International Journal of Gastroenterology)
Vol. 81, No. 4, Year 2010 (Cover Date: April 2010)
Journal Editor: Beglinger C. (Basel), Göke B. (Munich)
ISSN: 0012-2823 (Print), eISSN: 1421-9867 (Online)
For additional information: http://www.karger.com/DIG