Interesting Case of the Month - (IGHP, ICOM) - July
july 2026
Clinical History-
84-year-old female complaint of abdominal pain. UGIE showed duodenal nodularity. From the images below identify the likely disease?
Radiology-
UGIE -Paucity of duodenal folds with patchy areas of nodularity
Microscopic Images
Microscopic examination of Duodenal biopsy showed subtotal villous blunting with variable patchy increase in intraepithelial lymphocytes upto 30-35/ 100 intraepithelial lymphocytes. Subepithelial collagen deposition noted.
Special Stains Performed-
MT stain performed showed sub epithelial collagen bands
Diagnosis-
Celiac disease
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Tropical Sprue
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Collagenous Duodenitis
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Collagenous sprue was thought to be a form of malabsorptive disorder with the specific clinical and pathological features: (1) persistent diarrhea with pan-malabsorption causing nutrient deficiencies and progressive weight loss; (2) a biopsy lesion included a unique morphologic marker, a sub-epithelial band-like deposit with histochemical and ultrastructural features of collagen; (3) other pathologic changes of untreated celiac disease were present, but not responsive to a gluten-free diet; and (4) diffuse and patchy mucosal changes of variable severity, localized mainly in the proximal small intestine.Small intestinal villous and crypt atrophy, subepithelial collagen deposit thicker than 12 μm that entraps lamina propria cellular elements.
