VERY LATE MUCOSAL RELAPSE IN A GIRL WITH CELIAC-DISEASE

Small bowel biopsy in a 4-year-old girl with symptoms suggestive of co eliac disease revealed subtotal villous atrophy. The mucosa healed on a gluten-free diet. From the age of 7 years, the girl was challenged w ith gluten. Annual biopsies showed normal or nearly normal mucosa spec imens. At 21 years of age, after 14 years of gluten challenge, a mucos al relapse was found and a gluten-free diet was reinstituted. A biopsy one year later showed a normal mucosa. From this case report it is ap parent that a patient with a past history of subtotal villous atrophy, which after a preceding period of gluten-free diet does not recur wit hin two years of gluten challenge, must be followed carefully, so as n ot to miss a late relapse.