Type 1 diabetes mellitus, coeliac disease, and lymphoma: a report of four cases

Introduction Patients with Type 1 diabetes mellitus have a high prevalence of coeliac disease, symptoms of which are often mild, atypical, or absent. Untreated coeliac disease is associated with an increased risk of malignanc y, particularly of lymphoma. We describe four patients with Type 1 diabetes mellitus and coeliac disease who developed lymphoma. Case reports Two patients were male and two female. In three patients, coel iac disease and lymphoma were diagnosed simultaneously. Enteropathy-associa ted T cell lymphoma occurred in two patients, Hodgkin's disease in one, and B cell lymphoma in one. Response to treatment was in general poor, and thr ee patients died soon after the diagnosis of lymphoma was made. Conclusion As the relative risk of lymphoma is reduced by a gluten-free die t, a high index of suspicion for coeliac disease should exist in all Type 1 diabetic patients with unexplained constitutional or gastrointestinal symp toms.