Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.
Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de São João, Porto; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal.
J Gastrointestin Liver Dis. 2023 Jun 22;32(2):257-260. doi: 10.15403/jgld-4624.
A 74-year-old woman was admitted for weight loss, abdominal pain and diarrhea for a year. Blood tests showed elevated transaminases, cholestasis and hyperbilirubinemia. Capsule endoscopy revealed extensively scattered lymphangiectasias, shortened villi and erosions in the jejunum and ileum. The histological examination of the small bowel mucosa biopsies evidenced severe mucosal atrophy and crypt hyperplasia, without significant intraepithelial lymphocytosis. The clinical picture, lack of response to a gluten-free diet and endoscopic and histopathologic findings were compatible with autoimmune enteropathy. Simultaneously, autoimmune hepatitis was also diagnosed. The patient showed significant improvement after starting treatment with prednisolone and azathioprine. To our knowledge, this is the first case of autoimmune enteropathy diagnosed simultaneously with autoimmune hepatitis.
一位 74 岁女性因消瘦、腹痛和腹泻 1 年而入院。血液检查显示转氨酶升高、胆汁淤积和高胆红素血症。胶囊内镜显示空肠和回肠广泛散在的淋巴管扩张、绒毛缩短和糜烂。小肠黏膜活检的组织学检查显示严重的黏膜萎缩和隐窝增生，上皮内淋巴细胞无明显增多。临床表现、对无麸质饮食无反应以及内镜和组织病理学发现与自身免疫性肠炎相符。同时，还诊断出自身免疫性肝炎。患者开始接受泼尼松龙和硫唑嘌呤治疗后，病情明显改善。据我们所知，这是首例同时诊断出自身免疫性肠炎和自身免疫性肝炎的病例。
