Medical Clinic I, Gastroenterology, Rheumatology and Infectious Diseases, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
Digestion. 2010;81(4):231-4. doi: 10.1159/000269810. Epub 2010 Jan 29.
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-beta) 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.
肿瘤可能会影响免疫反应。在这里，我们报告了一位 72 岁的患者，他在 20 年前被诊断患有乳糜泻 (CD)。在正常饮食但没有肠病或与 CD 相关抗体的情况下，患者发生了空肠 T 细胞淋巴瘤。由于穿孔，进行了切除，并添加了四个疗程的 IMVP-16。患者开始并坚持严格的无麸质饮食 (GFD)。两年后，他出现体重减轻和克隆性难治性 II 型绒毛萎缩，上皮内淋巴细胞中抗原 (CD8；T 细胞受体-β) 表达缺失。此时，尽管他坚持 GFD，但他表现出高滴度的与 CD 相关的抗体。该病例报告强调了几个问题：在含麸质饮食下缺失的肠病支持恶性疾病（特别是非霍奇金淋巴瘤）中存在免疫抑制的观点。其次，患者在严格的 GFD 下发展出早期形式的第二种独立的 T 细胞淋巴瘤（难治性 II 型绒毛萎缩），然后出现与 CD 相关的抗体，这引发了一个问题，即克隆性上皮内淋巴细胞是否刺激了抗体产生。因此，在 CD 患者中单独检测与 CD 相关的抗体本身并不能证明其不遵守 GFD。
