Clinical presentation

On two consecutive days, two women, 82 and 76 years of age, were admitted with severe watery diarrhoea lasting for about 8 months. They presented with serious deconditioning and a weight loss of 16 and 20 kg, respectively. An extensive workup had yielded virtually identical results in both patients and led to the diagnosis of ‘refractory seronegative sprue’. There was no history of foreign travel or previous GI symptoms. Duodenal biopsy showed subtotal villous atrophy (VA) (figure 1) with an increased number of intraepithelial lymphocytes (figure 2). IgA and IgG tissue transglutaminase and endomysial antibodies, serum immunoglobulins, HIV serology, T-cell receptor rearrangement of intestinal lymphocytes, antienterocyte antibodies, colonoscopy with …