OCCULT CELIAC-DISEASE ASSOCIATED WITH LYMPHOCYTIC SCLEROSING CHOLANGITIS

A 60-year-old male with dermatitis herpetiformis and a previously trea ted lymphoma involving an inguinal lymph node developed abnormal liver chemistry tests. Because of intermittent diarrhea, additional studies revealed lymphocytic colitis and occult celiac disease that responded to a gluten-free diet. A liver biopsy done to explore persistently ab normal liver chemistry tests showed a portal tract-centred inflammator y process characterized by biliary ductal proliferation, epithelial ly mphocytosis and concentric lamellar fibrosis. Quantitation of immunogl obulins was normal and antimitochondrial antibodies were negative. Ret rograde cholangiograms showed radiological features typical of primary sclerosing cholangitis. The epithelial lymphocytosis reported in gast ric, small and large intestinal mucosa of some patients with celiac di sease may also be present in the biliary ductal columnar epithelium. T his report provides additional evidence that celiac disease may be a f ar more extensive pathological process.