Hyposplenism, antiendomysial antibodies and lymphocytic colitis in collagenous sprue

A 66-year old woman was seen repeatedly over a decade to remove recurrent c olonic adenomas and investigate episodes of watery diarrhea. Although the d iarrhea was believed to be due to lymphocytic colitis, she developed weight loss, hypoproteinemia and hyposplenism that resulted in further stud ies, specifically to exclude celiac disease. Small intestinal biopsies, however, showed severely 'flattened' villous architecture with trichrome-positive s ubepithelial collagenous deposits, characteristic of collagenous sprue. Ant iendomysial antibodies, known serological markers of celiac disease, were a lso detected. While collagenous sprue has been considered a distinct small intestinal disorder, the constellation of clinical and pathological finding s in this patient suggests a close link with adult celiac disease.